Assembly Standing Committee on Military and Veterans Affairs

So good afternoon, everyone. This hearing of the Assembly military and Veterans Affairs Committee is called to order. We will be just in interest of everyone's time and to respect the fact that folks were here early, we will be opening as a Subcommitee to begin the hearing. And so I want to welcome everyone who is here presently, also to my Committee Members, the Vice Chair. Thank you for being here. Exciting that this is actually my First Committee as a new Member.

And then being able to chair is a true just honor. So thank you to all our guests who are here. So we're going to, as I mentioned, move on as just as a Subcommitee because we don't have a quorum. What we'll do is I want to welcome all of you to the first hearing of this session. I am honored and excited to serve as the chair of this Committee and also to hear today from CalVet and in particularly from Secretary Vito Imbaciani.

Thank you so much for being here. The subject of today's hearing is reform, consolidation and transition. So I'll explain briefly what I mean by that. I think it should be uncontroversial to say that the period before Dr. Imbasciani's appointment was one of underperformance for CalVet. And we kind of chatted right now. Sidebar and I think we share some of the sentiments and that we also saw scandals, both minor and major, which with bruising audit findings, poor conditions at the veterans homes.

And so I think that the record is cleared. It's not a secret. And so we also have a record, though that is also clear that during the period since Dr. Imbasciani's appointment, he has brought a great deal of improvement. The veteran homes are performing a lot better on federal inspections. CalVet has brought a great deal of control and scrutiny to how the homes are used.

We are investing substantially in the homes with the construction of the new skilled nursing facility at Yachtville, and the Department has set a course for the future of its services to veterans anticipating a changing population with changing needs. I would also be remiss of me, not to mention the department's performing and managing the COVID-19 pandemic.

The Department and you personally, Mr. Secretary, have earned our gratitude for protecting the veterans in your care when there were so many examples across the County of similar facilities failing with deadly consequences. You guys did an extraordinary job.

But the secretary's impending departure to the California Institute for Regenerative Medicine, and I want to again congratulate you publicly on your appointment, by the way, demands questions about how we can sustain these improvements, keep the course that we've set, and turn the better planning and policy of the last few years under your purview into permanent or semi permanent conditions so that we can continue to serve all of our veterans the way that they deserve to be served.

So I want to go ahead and begin by allowing Dr. Imbascianito say a few remarks, and following that, we will talk about the master plans for the California Veterans homes and conclude with a discussion of two of the Kelvit's Newitz programs, which is the Veterans support to self Reliance program and the Veterans Health Initiative. But first, I'd like to provide a brief introduction of Dr. Imbasiani for the benefit of the Members of the public and also for the Committee Members.

So Dr. Imbasciani was appointed by Governor Jerry Brown as the 16th secretary of the Department of Veteran affairs in September of 2015, and he was reappointed by Governor Newsom on January 22, 2020. He's a physician by training, having completed medical school at the University of Vermont College of Medicine and his surgical and urological residency at Yale New Haven Hospital and the West Haven VA Hospital. And he is also a soldier.

He was commissioned in the Medical Corpse of the United States army in December of 1986 and retired after 27 years in 2014 with the rank of colonel. He deployed four times in support of the wars in the Gulf and received the Meritorious Service award, the Combat medic badge, the Army Commendation Medal four times, not just once, and the California Order of Merit. And he earned campaign ribbons for Operation Desert Storm, the liberation of Kuwait, and the global war against terrorism.

He leaves Calvet to assume a new role as the chair of the California Institute for Regenerative Medicine. What a remarkable track record and just journey to get here. Thank you for your service. And we'll want to proceed, Mr. Secretary, to say your remarks. And then just for the purpose, for our Committee Members, we have a series of kind of various panelists that will be giving some words and sharing what the work they've been doing.

But if you guys have questions, please kind of let me know so that at the finale of every presentation, you guys can ask any questions. Thank you. So, Mr. Secretary.

Good afternoon, Madam Chair and Madam Vice Chair, Members of the Committee, and thank you for that wonderful preamble. Very gracious of you to say those very nice words about me. It's been a few years since we've been able to do this in person, meet publicly. Due to the pandemic. I would like to extend personal greetings and thanks to each of you returning and new Committee Members for all that you do to support California's veterans.

This is, sadly, the last time I will address the Committee as secretary of the California Department of Veterans Affairs. In two weeks, I'm going to be sworn in as the Chairman of CIRM, California Institute of Regenerative Medicine, which is the agency of state government that funds all the stem cell research in California. So today is bittersweet for me because it means I have to leave CalVet.

And it's very dedicated and compassionate staff that I'm surrounded by my wonderful undersecretary and nine deputy secretaries and some of their staff. This has been the honor of a lifetime. The folks here at CalVet take to heart the honor, the privilege, and the duty of caring and advocating for California's almost 1.6 million veterans and their families. Together, we've grown CalVet into a Department that is prepared to fulfill its mission for the coming decades and beyond.

Today, I'm going to share with the Committee our greatest accomplishments from these past seven years. But I want to set the stage for where we can go next, and I'll offer some parting remarks. And then you're going to hear from some of my talented team, who are the real subject matter experts on all our programs and all things veteran here in the great State of California.

But first, when Governor Brown appointed me to this post in 2015, it came with a mandate to modernize and reinvigorate an agency that lacked a clear identity and culture. At the same time, many of our programs required great expansion in scope, and some of our challenges required thoughtful prioritization. Fortunately, CalVet was blessed with excellent deputy secretaries and staff already on board, some of whom you will hear from today.

With our recent additions to our deputy secretary ranks, they form what I believe to be an exceptional leadership team. And because of our work over the years, I can confidently say that more veterans and their families throughout California are now connected to CalVet in many or multiple ways we have regular, positive engagements with our many stakeholders. And the department's reputation, I am so proud to say, is at an all time high. First, let me begin with details about our veterans home.

In 2015, the eight veterans homes of California were standalone entities that came out of our history. They lacked the cohesion and efficiencies of a modern healthcare network. Many of the homes were struggling with lower than acceptable star ratings from the US Centers for Medicare and Medicaid Services CMS. They operated with disparate processes and outdated technologies. With the Legislature's help, we organized the eight homes into a single system with standardized practices across the workplace.

So now I'm able to report that all six of our CMS rated veterans homes are rated at either four or five stars, putting them among the top skilled nursing facilities nationwide. In fact, the nation's largest and oldest continually operating veterans home in the nation, our 139 year old Yountville home, just received a five star rating from CNS last month. Additionally, all eight of our homes consistently excel in annual licensing surveys from the VA and CMS.

Three of them, Lancaster, Ventura and Fresno, have earned the nationally recognized Joint Credit Commission accreditation as well. That's a pilot program that I expect to expand to all eight homes in the near future. There are two flagship projects underway in our homes that I'm most proud of. We've got a new skilled nursing facility under construction at Yountville in Napa County. It's going to open in 2025 with its 240 beds.

This State of the art hospital will represent the first new freestanding building at the Yountville home since 1978. It will replace the current Holderman hospital, which opened in 1932, and will position the home to provide the best in health and memory care for decades to come. Last fall, we launched our California electronic health record system care CEHR at our West Los Angeles home.

We expect to have half of our homes go live on this electronic medical record by this year's end and all homes by the end of 2024. This project has been years in the making. When I arrived, it became my first strategic priority and remains so until it was deployed in October of last year. The new electronic health record system ensures that our residents receive more efficient care through the use of modern technology and through our new electronic prescription service, called ePrescribe, which was unveiled in 2021.

Our residents are now enjoying a streamlined process for getting their prescription medications. These milestones in veterans care were only achievable because we set out to create a network of veterans homes that regularly communicates, collaborates, and receives strong support from our headquarters team, represented by the front table here. This structure was also crucial while battling a once in a generation global pandemic, which, as you know, hit the elderly population and especially long term care facilities much harder than most.

These last three years have been tough on our workforce and our residents, but we made smart decisions about closing our homes to visitors early on, and it made all the difference, and I believe as a result, we were able to save many result, many lives because of the work we're currently doing and the milestones we have achieved. The current State of our veterans homes is now distinguished by compassionate care, high performance standards, and technological innovation.

We did this with both the present and future of these homes in mind, as we have laid out in great detail in a network wide master plan and two individual master plans for individual homes. We know that California's aging veteran population today is different from that of previous generations, often distinguished by increased rates of multiple medical ailments and the need for higher levels of care. Therefore, it is CalVet's goal to move away from domiciliary care.

Domiciliary care is room and board over time and focus primarily on those who need higher levels of care, most notably skilled nursing and memory care. A higher need population in California, however, may signal more demand in the future, including requests to build one or two more veterans homes here in California. For this reason, Calvet has established in our master plan five rules to live or to build by before any new homes should be attempted. My staff affectionately refers to these five rules as Vito's rules.

I'd be honored if you continue to do so. Rule number one, demand if you're going to build a new veteran's home, put it in a place where there's a large veteran population nearby and that there's evidence showing sufficient need for facility based, as opposed to home based long term care. Rule number two, location. Any new home should be no more than an hour and ideally less than 30 minutes away from an existing VA facility. Rule number three, care.

Ensure that the levels of care or other services that we provide at the veteran's home are reflective of the veterans needs which are otherwise unmet by other service providers in the community. Number four, infrastructure. Check that the local healthcare infrastructure can meet the home's operational and clinical needs based on the size of the home. Translated into English. Make sure there's people in the community we can hire to work in these homes. Rule number five workforce.

Where the cost of living is affordable and where the local available workforce of nurses or other licensed or certified specialists is of sufficient size to meet our staffing needs. That issue number five, workforce, and in particular our healthcare workforce at the veterans home, has become in the last two years a top concern that we're working daily to address.

Clinical nursing positions in our veterans home are unfilled right now due to many factors, but if we are unable to fill these positions, we will not be any longer able to admit more veterans into our care. As we established in the 2020 Master plan for all eight homes, some of our locations have more difficulty recruiting from a pool of qualified and certified personnel from the surrounding area. The shifts in workforce as a result of the pandemic have only exacerbated this challenge.

To address the issue of workforce shortages, we're proactively working on several initiatives, including, but not limited to ramped up recruiting and hiring fairs, accelerated hiring processes and continued use of the nursing registry. This is a priority issue for our Department, as it is for other departments of state government, and the team continues to identify possible solutions. We also have aging infrastructure needs in the homes that must be prioritized in the budget every year.

Maintaining the welcoming, safe and homelike environment of our homes is critical to our providing top notch, quality care to our nation's heroes. Those are key considerations when it comes to expanding the veterans home network. Next, I'd like to talk about our second oldest program at CalVet, the Veterans Home Loan program, which turns 102 years old this summer. It was first established by the state Legislature in 1921. The program gained $1 billion in renewed bond authority as part of Proposition one on the ballot of November 2018.

This has enabled us to continue to provide home loans to veterans and their families for at least a few more years. This CalVet home loans program, in fact, preceded the federal VA's program that is similar in many ways to ours, including some of the financing mechanism. California voters have supported all 27 previous ballot measures to continue funding this program, which, by the way, has granted home mortgages to 426,000 California veterans.

But we cannot take for granted that they will rubber stamp a 28th ballot measure as well. We must keep supporting this valuable program. Another piece of the puzzle that helps the entire state tackle our affordable living crisis. We're just one piece of the big puzzle. We know home ownership builds generational wealth. CalVet's ability to lend to veterans that may not be able to receive a loan elsewhere on the commercial market sets up California veterans and their families for generations.

There are other ways in which CalVet leads the nation in serving veterans, too. When I arrived in 2015, we were just getting the VHHP program, Veterans housing and Homelessness Prevention program, off the ground. The voters of California had approved Prop 41 the year before that provided $600 million for the development of new affordable housing for veterans and their families, emphasizing veterans who are homeless or who have extremely Low income.

I'm very proud to share that as of today, we have funded 88 construction projects totaling more than $484 million and these projects, when completed, will have built 3100 housing units designated specifically for veterans. In 2017, we created the California Transition Assistance Program, or CALTAP.

This high energy program allows our teams to inform veterans of all eras, not just 20 year olds leaving the marine base at Pendleton, but veterans of all ages, to connect and learn about their earned federal and state benefits and connect them to community based systems of care. CALTAP also provides continued support and assistance as veterans needs continue to change over time. Since its inception, CaLTAP has served nearly 24,000 service Members and veteran participants.

That team adjusted on the fly when the pandemic hit, switching from in person visits to webinars in order to continue reaching veterans. They have hosted roughly 475 webinars, including 100 of three of them in 2022 alone that drew more than 4100 participants. We're now back to about a 50/50 split between in person presentations and virtual events. We partner with 57 institutions of higher learning from the UC campuses to the CSU campuses to our community colleges.

We reach military personnel through 39 Department of Defense installations, including all active duty, Reserve and National Guard facilities. Many veterans pursue a degree or a certificate after military service, but unfortunately, not all schools and programs have the veteran students well being in mind. Our California State Approving Agency for Veteran Education, or CSAVE, has ensured stronger protections for student veterans and their dependents when using their educational benefits.

CSAVE has identified and stopped, with the help of the Attorney General, fraud, waste and abuse among bad actor institutions as well. Our division for Minority and underrepresented veterans is very active in engaging veterans from the LGBTQ and BIPOC communities through programs such as Pathway to citizenship, recognition, webinars and outreach events. The Women's Veterans Division connects with the roughly 163,000 California women who have served in the military through campaigns like women, veterans voices, operation Dress code and annual recognition, like Women's Military History Week this week, t

These divisions are well positioned to expand their reach to our traditionally underrepresented veterans in California and are at the table to provide input about how we can better serve these populations. In conclusion, I am proud to report that I leave a California Department of Veterans affairs that is strong, vibrant, healthy, effective and forward looking. I would like to acknowledge and thank CalVet's dedicated leaders and staff for getting us here, especially my undersecretary and nine deputy secretaries.

I want to express my sincere gratitude to the Legislature and the Newsom Administration for the strong support for this Department. Without this robust partnership and positive working relationship, we would be so much farther away from fulfilling our mission. While there's always more work to be done, I leave CalVet confident that we are accomplishing our vision of making CalVet the national model for serving veterans and their families.

Nowhere else in the union will veterans find better long term care, stronger education protections, a friendlier home loan lender or a better connected, community based network of care. California is truly great state for veterans. Thank you, Madam Chair.

Thank you, secretary, for that overview. I wanted to check in with my Committee Members, see if there are any questions to the secretary.

I don't have questions, but I just wanted to.

I am honored to be part of this committee, and I'm looking forward to working with you to continue to provide housing to our veterans. Something that, again, we are very active in the Antelope Valley High Desertino district that I represent, district number 39. Looking forward to that collaboration. Looking forward to bringing those resources that are lacking in the Antelope Valley. A lot of the Members have to go all the way down to UCLA, which is about not an hour with traffic.

It takes sometimes 2 hours to get there. We need to work on getting those resources up to where their veterans live and not make it even more difficult for them, especially because the lack of reliable transit makes it even more challenging for them to access those services. Just wanted to reiterate my commitment. I'm looking forward to working with you, and it's a pleasure being in this committee. Thank you for what you've done.

Thank you for your words, sir. I should tell you that the Antelope Valley is one of the fastest growing areas because of the community itself, but also Edwards Air Force Base, further up the road of veterans in the community. We have devoted a lot of our dollars and sweat equity up there in Antelope Valley. I have been at every one of the ribbon break openings for the homes up there. In fact, one day, very memorable.

It's the only day because it was 120 degrees and I was in the direct sun that I publicly took my bow tie off. The only time, I think, in 30 years we will continue to support your community with its housing needs. It's extraordinary. Thank you.

Thank you, secretary. Thank you so much. And thank you for leaving Cal Vet in such great shape than when it first was when you came. So we thank you for all your effort, and I know that your staff and team were behind that as well. I represent the 74th district, and that's South Orange County and north San Diego. So I've got Camp Pendleton, Oceanside, Vista, and San Clemente. So we have a lot there.

And I'm very grateful and blessed to have this opportunity to serve on this Committee and thank you for everything you've done, and I look forward to working with everyone in the room.

We look forward to working with Orange County more closely in the very near future.

If no other questions. Thank you, Secretary, I do have one question for you, as you did a remarkable job in outlining, really, the accomplishments over the last few years in really making sure that Cal Vet is a national model to ensure that we're serving our veterans.

But I did have a specific question as it relates to everything that you've done. So what do you feel from your perspective, given that you're transitioning out, that needs to be done to ensure that everything that you've done with your team, obviously, in terms of policies and initiatives from your term, are continued to be carried forward because we are seeing some of the success of it.

And then what do you believe it's our role as Members of the Legislature to ensure that the vision that you set, the goals and the strategic planning that you guys have put in place continues to be followed?

Chairwoman, thanks for the question. I would not change anything, actually, because the Legislature and I feel the love from all sides, both houses, everyone, because that's the nature of the veteran experience and world. Everyone in California supports its veterans. The Legislature has been extraordinary in opening your doors to my staff and your ears when we bring you problems, when we cry on your shoulder sometimes we have some real needs. Some of our homes, including Yountville and to some extent, Barstow, the older homes have extraordinary. What's the word?

I'm looking infrastructure. Yes. The kind of repairs that need to be done on our infrastructure. The buildings at Younfield were old on Pearl harbor day. Okay, so, like, we have a story hospital. We're going to move into the new building. But when elevators break, well, the manufacturer of those elevators, they went out of business 40 years ago. So tool and die makers have to recreate pieces for us piecemeal. And sometimes the veterans that live in our homes are impatient.

Keep an open heart and an open mind toward our extraordinary isolated needs. That's number one. But you've already been doing that, so I would not change that. What I referred to as the most acute problem, and it's one not only faced by Cal Vet, but the state hospitals, the developmental centers, the prisons, and every other nursing and hospital facility in the nation, civilian, military.

We're all facing a workplace shortage that was exacerbated by not just the pandemic, but the bizarre, almost predatory practices of creating these programs where you give extraordinary hiring bonuses and other kinds of allotments to people who travel . And when I say travel, I mean it doesn't mean that we hire a nurse from Arkansas. But a nurse from UCLA will go across the street to work for Cedars Sinai in LA as a traveler.

So these extraordinary things that have put tremendous pressure on our ability to hire entry-level nurses, technicians, therapists, dietitians, the whole panoply of services. We are no longer competitive with the free market. Why is this a crisis? Because if I'm stealing you guys, you got it. We have to operate under the same state laws set by Department of Public Health that every other entity, whether it's Kaiser, Roseville, or, you know, a Sutter hospital or Cedars or UCLA.

Staffing ratios, depending on the level of care, Medsurge nursing, ICU nursing, neonatal nursing, in law are staffing ratios, meaning how many hours a day must a human with a medical or nursing credential touch a patient? When you drop below those staffing levels, you have to not admit to that unit. We have already, correct me if I'm wrong, we've already stopped admitting to our veterans homes, even though we have a long waiting list, because I cannot meet the legal requirement, because I can't hire enough people.

Some of our homes, not all, but some.

Thank you. He's here to keep me honest. In some of our homes. I would not change anything because the Legislature has been extraordinarily supportive and so has the Administration. I think with our good reputation, they trust us that when we come to you, it's with a true situation. You can believe us, and we welcome your help. And I'm hoping that I can't tell the Governor whom to replace me with.

I'm hoping that he finds someone, some man or some woman, who is able to hit the ground running and knows as much about these programs as I have come to learn.

Thank you so much, secretary. And I appreciate you bringing up the issue of the workforce because we're seeing that be an issue, really an issue of our time. In my district alone, we just had a hospital closure because that was one of the factors on top of other factors in terms of workforce, 40% of the nurses being travelers. And so we definitely have to figure out how we tackle that. So thank you for bringing that up. Assemblymember.

Thank you, Madam Chair. Mr. Secretary, thank you so much for your work on this extremely important topic and demographic. A question that I have is, in your experience of service, what do you think has yielded the best results in terms of what, in your experience, has yielded the best results in terms of investing in our veteran community? Right. Has it been veteran housing, veteran health care, specific services that the state provides to veterans?

Moving forward I think we're going to have some very candid conversations about the fiscal state that we're in. So just something that maybe you could leave us with.

Sure. Well, the people through the Legislature asked Cal Vet to be created to do three things, which is why I'm here. One is to take care of our destitute and elderly and alone veterans, and we do that through our veterans homes of California. But we have 1.6 million veterans. But how many are in the homes?

2300. A little over 2000.

2300. And yet the veterans homes of California occupy three-quarters of my workforce and about three-quarters of my budget. Okay. So there's a disproportion there. The second program is the home mortgage program. Extraordinarily successful. In a sense it's a model for the nation because we loan money to veterans who can't compete because of low-credit rating, low FICO scores on the competitive market. And yet Cal Vet does this with one of the lowest foreclosure and delinquency rates in the nation compared to any bank.

How we do that maybe is a little outside the scope of this meeting, but I'm happy to share that with you. It's legal and above board. Okay. It really is. But it's very successful. And like I say, we've given mortgages to almost a half million veteran families. The third program is where we reach every other veteran, and that's through the veteran services. The three reasons why Cal Vet exists, and it's such a big program, and we have three deputies sitting behind me now. One, Virginia Wimmer, is.

Maybe she'll raise her hand. Is our deputy secretary for women's veterans social. Rodriguez Murio is deputy secretary for minority and underrepresented. And Keith Boylan for veteran services. These are the programs through whether we're going on to the active duty military programs, military installations, whether we're going to the veteran resource centers on every single one, practically of the community colleges and UC systems, whether we're going into all the prisons.

One person goes in to each prison almost every day of the week, one day a week per prison diversion courts, the disabled, veteran business enterprises is supported by veteran services. So the question how can we do even better or capitalize? I would love to be able to connect to all 1.6 million veterans in California. We struggle with the federal VA and the DOD to be able to do that.

There are federal processes in place that make it difficult, but the folks behind me are constantly coming up with new programs, webinars outreach, citizenship programs, LGBT forums for veterans who were kicked out of the military because of don't ask, don't tell. We help them to get back into the good graces and connect to their federal benefits. It's connectivity. That's the future of Cal Vet and our Cal Tap transition program, our online curriculum, which we've developed that's accessible to everyone.

I think the federal VA recognized this as the first in the nation. They honored us with an award. They think that, oh my God, every state should do this. This is a curriculum not just for the 20-year-old who's leaving the Air Force in Elmendorf in Alaska or the sailor in Okinawa or the Marine at Pendleton, the 23,000 of them every year who make California their home.

They must know about California's benefits because we are the most generous state in the union, with one exception about taxation of military benefits, in which case we're the only state in the union that doesn't do that. And then we have part of this curriculum.

If you are a 30-year-old looking for job training, if you're a 45-year-old and you want to educate your children at a CSU college through our college fee waiver program, if you're a 60-year-old, need a mortgage, if you're 75 and you have no family left and you want to come into one of our veterans homes, or if you're a surviving spouse and want to bury your veteran spouse in one of our cemeteries, the curriculum is cradle to grave. It was genius.

We appreciate the Legislator's help in creating this. Every other state wishes they could copy us. I hope I answered your question.

You did. That definitely gives me a sense and direction. And as a former Anaheim City Council Member that supported the approval of the veteran cemetery in our lovely City of Anaheim. And then now, as a newly elected Assemblymember, I look forward to continuing to support our veteran community here in California. Thank you.

Thank you so much. I think if there are no other questions, we'll move on to the second part of the agenda, which is the master plan for the California Veterans homes. I know that we have Cal Vet staff here, starting with deputy secretary from the homes division, Coby Peterson, and chief of the veterans home operations, Thomas Martin. And if you guys could go ahead.

Okay. Thank you very much. Good afternoon, Madam Chair, Members of the Committee. My name is Coby Peterson. I'm the Deputy Secretary for the Veterans Homes. And as was mentioned, I have with me my right hand man, Thomas Martin, who is the Chief of Future Operations and Plans. Thomas Martin and his team are the architects of the master plan.

And we've been asked to come here today to talk a little bit about that and I'll try to get quickly through my portion because I'm sure that's what you want to hear about is the master plan. We are happy to have the opportunity to share with you some updates about our program to caveat what the secretary said and kind of talk through what we think the future holds for our veterans' homes. I would like to start, however, by acknowledging and thanking our secretary, Secretary Imbasciani.

We are all over at Cal Vet very sad to see him leave. We are very happy for him. We know where he's going is going to be a tremendous asset to that organization. And I can assure the Committee here that he's leaving Cal Vet in a much stronger and more effective organization than he found it. I can guarantee that. And I can't thank him enough for the support that he's given to the Veterans' homes and his strong leadership. And we are certainly going to miss him.

But thank you very much, sir. So today I sit here before you and I'm very proud to say that every one of our eight veterans homes is operating at an extremely high level. Quite a contradiction from what you talked about at the beginning. But I was here back then. I just started and sort of inherited that. But it's really nice to be able to sit here full circle several years later to talk about how far we've come.

Many of the homes are and have been rated as being among the best in the country by such organizations as the Joint Commission on Accreditation, publications like Newsweek and US News and World Report, which has ranked several of our veterans homes for the past 3 and 4 years as being some of the best in the country. Medicare has rated all six of our skilled nursing homes in the 4 and 5-star ratings.

And as of today, five of my homes are at five star and one is at four star, which is tremendous. And that one that's at four star just passed CMS survey a few weeks ago with very few deficiencies. So we're really excited about that home. This puts those homes in the top tier of nursing homes across the country, which is remarkable compared to where we were.

Cal Vet has also received national recognition for its rapid, effective response to COVID-19 and I have no doubt that the homes have saved many lives in the process.

These accomplishments would be impressive enough if it was normal operations, but we spent the last three and a half years plus going into our fourth year of the pandemic and being able to achieve those types of successes with the effects on staffing, morale, and operations is just truly a testament to the staff that we have the amazing leadership, and we are incredibly grateful for the team that we have. The folks that are on the ground dealing with this day in and day out.

Because with a national shortage on nursing and being able to achieve national recognition in so many buckets is a testament to those folks and we can't say enough about them. For the past eight years, the homes division has simultaneously been operating on a day-to-day basis of trying to improve. When we started, we had a lot of stovepipes, and we're in a position right now where we have pretty much standardization across the board, but we've never lost focus on planning for the future.

We are well aware that we are in the midst of a sea change with regards to the veteran population, and I think Thomas's folks have calculated in the next 25 years we're going to lose 40% of our veteran population. And that veteran population in the next 25 years is going to be different than the population that we serve today.

So as we begin to move away from the emergency pandemic response, we are rededicating our efforts into the long-term planning that's been laid out in the master plan. When I came to Cal Vet, we were primarily serving World War II veterans and Korean War veterans, and that was 89 years ago. Sadly, today we have few World War II veterans remaining, and our majority population of veterans that we're serving are Vietnam veterans, Peacetime Veterans, and Gulf War Veterans.

And in 10 to 20 years, that's going to change completely. So as the veteran population changes, we have to plan for how their needs are going to change as well. And that's what leads us to the master plan. So at the direction of the Legislature and the Governor, we began a formal process to reassess the veterans home system by developing two types of master plans.

The first master plan is a comprehensive, system-wide plan that looks out a decade or more at the veteran population that California will have and how to best meet those needs. The second type is a master plan that is an ongoing series of home-specific plans that takes a look at each location separately and evaluates the best ongoing use of the property.

So the 2020 master plan explored the changing veteran landscape, the current strengths and weaknesses of our veterans homes, and provided a roadmap for the future which we are currently following by the way. This document was so comprehensive, so impressive, that it has been sought out by other states, other states, veterans homes.

And I think Vito told me and Thomas told me the other day that five states have seen it and are using it as their own model to create planning for their futures because they see the same things that we're seeing. So it's really incredible. It followed years of research by our talented staff, Thomas's team. It included stakeholders and elected leaders. So it was a very comprehensive document. The community supported it, the veterans community supported it.

And if you haven't had the opportunity to read it, it's worth reading. And we've already begun the second iteration because by law, we are required to update that every five years. So Master Plan Two will be out in 2025. Now, what we have done, in addition to the original master plan, is we've created two home-specific plans, one for Barstow and FY 21 and one for Yaville and FY 22.

And I am going to hand it over to Thomas, who's going to talk a little bit about the specifics, and then we'll wrap it up at the end and we'll address any questions that you have. Thank you very much.

Thank you very much. So, as Coby mentioned, we have the two types of master plans. So the first system-wide master plan came out in 2020, and that focused on establishing a baseline for the system. So trying to understand the trends in the veteran community as well as what's happening in our homes. So what are the strengths, what are their challenges, and how to think about how we should plan for the future based around that.

As Coby mentioned, there's a significant stakeholder engagement process as part of it, with elected representatives, with our staff, veterans groups, probably most importantly the residents in our homes, to try to get a feel for what they need from us. And that was a really big part of it because philosophically we try to focus on need and not necessarily demand. So where's the unmet need that exists in the veteran community that isn't met by other services, or at least not fully met by other services.

And that's where we start to look at looking away from things like the domiciliary, the independent living room and board program the secretary mentioned, towards things like skilled nursing, things that are expensive, there's no way around that and are difficult for other providers to be able to offer. So nonprofits, those types of entities, it's hard for them to operate a skilled nursing facility, whereas there are options for housing programs or things like that to include other programs that Cal Vet has.

So as part of this, well, understanding the current state of the homes and the current state of the veteran community, that's a worthy goal in and of itself.

But we also recognize the need to define our path going forward, similar to the master plan on aging, trying to have a broad, comprehensive look at everything that exists, everything that we're doing, all the resources we have, all the programs we have, and decide from there, build a vision from there for what role we should play and what part of the broader ecosystem, what niche we should feel.

So the first master plan, the recommendations were focused on finding those unmet needs and addressing some of the most critical challenges in the homes, many of which involve the Barstow and Yountville homes, either because of the age of the facilities, primarily in Yountville's case, or because of geography that might hinder things like being able to connect with the veteran population or building a strong workforce. Those types of areas. The Yountville master plan was released a couple of months ago, end of last year.

The Barstow master plan was released the year prior. They're going to be updated every five years. Each of these site-specific master plans gets updated on a rotating basis, just like the system-wide master plan. And the goal of the 2020 master plan, as I said, is to build a baseline and have all the other master plans just build on top of it, that there'd be a general vision that we could work from and the other plans would be iterative or adding more value to them.

That's what we did with the Barstow and Yountville reports. So they followed on those steps and they reiterated and built on some of the goals that were outlined in the 2020 plan. So some of the key ones, there were 27, it's quite a few. But some of the key ones for those homes were moving away from one of our outdated levels of care, our independent care program, and replacing it with assisted living, which is more modern, easier to manage, something you'd find in the private sector.

And as the secretary mentioned, stepping away from our independent living program, particularly in Barstow, with the goal of replacing it with more skilled nursing beds, which we see as the true, the greater unmet need, particularly in that region. And then most importantly, as the secretary mentioned, building the skilled nursing facility in Yountville being probably the single most important recommendation coming out of the 2020 master plan, which we've reiterated. So those goals are all being implemented at this time.

By the time they're done, those two homes in particular will look very different. There's going to be fewer independent living beds. The levels of care will better align with the community need, which is based out of Vito's rules. We'll make sure. That 2025 match plan Vito Imbasciani memorial, something something rules. It'll be in there.

And also, the other big thing, big change for the campus is really going to be revitalizing Yountville, reinvesting in it, addressing key maintenance challenges, the most important one being replacing the Great Depression-era skilled nursing facility with a nice new, modern one. So veterans are changing. Like Coby said, we're in the midst of a sea change. Veterans we have today, they're not the veterans we had 10 years ago.

And the veterans we have 10 years from now are not going to be the ones we have today. By the end of the decade, we're going to lose almost all of our World War II veterans. We'll have very, very few Korean War veterans. And we're really going to be serving Vietnam veterans primarily. And the first wave of Gulf War veterans, they'll be aging up into our type of programming. And so when we're talking about what the future means, it's not just about buildings.

It's not just about where they are. It's also about what exact services and care those veterans are going to need. What are their care needs, what are their preferences from a whole range of topics, not just medical care, but dietary, what preferences they have that are just not the same as what we've been seeing.

So these master plans and the upcoming 2025 master plan, they're going to be setting Cal Vet on the best footing to be able to meet their needs in the future, and we're looking forward to be able to using that for the next 10 and 20 and unknown number of years to be able to guide our decision-making process. So with that, we look forward to working with you and your representatives on the next master plan.

We'll have stakeholder engagement coming soon on that and just want to thank you for the opportunity to discuss what we're working on, and I'll hand it back to Kobe.

So, as you can see, there was a reason why we picked Thomas to lead the master plan. He really understands and he's committed to the needs of our veterans in the futures. He's at the forefront. We've got a tremendous amount of folks that want to talk about it and get involved. So we were getting tremendous levels of support. So I feel that we're in a great position.

We've got a great original document that we can build on, and then we've got a series of documents that will continue to come forward. So as we conclude, I think it's important to recognize that and let you all know that we feel like we have an incredible team right now in Cal Vet, in the homes division, probably some of the best leaders we've ever had and folks down on the grounds, in the trenches on a daily basis.

It's funny we say that because right now CMS is at Yountville on day two of their survey. It pretty much never ends, but we're ready for that and we're prepared. We've had a tremendous amount of accomplishments. I know it sounds like it's just been in the last few years, but it's been several years and it's taken a while and it didn't happen overnight, and it certainly was aided by the secretary's leadership and prioritization and support.

But it's been really nice for me to see because I've been able to see where we were and where we're at and where we're going. And to answer one of the questions that was asked earlier, are we going to be able to maintain this level of success? And I think the answer is we have the same team now that we had to develop where we're at now, with the exception of the Boss.

He's taught us many lessons, and I think that we are committed to making sure that we continue down this path. I think the master plan guides a lot of the decisions going forward for the homes division, and I'm sure Keith can talk the same things about his Department when he gets up here in a minute. But I think we're in really good shape. I do want to caution and let everybody know that we still have challenges with the pandemic.

I have homes right now with cases of COVID and we're testing folks on a regular basis, and we're isolating folks, and we're still dealing with COVID living with COVID I guess the best way to explain it. But in spite of all of that, we're incredibly proud of what we've been able to accomplish. It certainly didn't happen by my leadership, but I think, you know, good leaders surround themselves with great people, and I think we've done that and we're planning for the future.

Thomas is committed to handing this to whoever he hands this to, and we'll continue to do it because it's just a great framework for the future. And I think the future looks bright for the veterans' homes. I don't think there's a whole lot to be too concerned about right now. And we appreciate the opportunity to be here today, and we welcome any of your questions.

Thank you for that presentation, Deputy Secretary. And then also Thomas for all that information, I had some just follow-up questions, and then I'll also ask my colleagues to see if they have any additional questions. One, I want to go back to a comment that I think was mentioned by the secretary about the challenges in workforce and then some of the stopped admissions to some of the homes.

Can you identify maybe what homes are the ones that, where you guys have kind of backed off on admitting folks?

Are we talking about nursing shortage homes specifically?

Okay. Yeah, the vet homes.

Yeah. So it was really interesting because when I got here, we always had a little bit of challenge recruiting and retaining folks in two of our homes. They're located in the most high cost of living areas, Yountville and West LA. But yet we still were able to get folks.

And what we started to see is a trend and a change when the pandemic happened is we were all of a sudden starting to see nursing challenges, hiring in Fresno, in Redding, and we were never seeing these before. I have my folks give me the report on a weekly basis of how we're doing regarding census. And we're operating right now at about 70, little over 70% census fulfilled prior to the pandemic. We're in the high 80s.

So we have had an effect and we've had to shut down some of the homes based on patient hour per day, based on licensing requirements. And we're not losing sight of that. We are on top of that daily. It's my number one priority. It's been my number one priority for several years as to how do we improve vacancy rates so that we can increase census rates. It's what we talk about all the time.

And I was actually encouraged when I got the report last night that some of our vacancy rates for nurses is going down. And I'm actually hearing our weekly meeting about new employee orientation. We just picked up five more CNAs, two RNs, a psychologist. So I am seeing light at the end of the tunnel. The biggest challenges that we're having right now are obviously continue to be West LA, Yountville, Fresno was a challenge and Redding, but I think both of those are on the mend.

We're actually admitting. We just admitted a few folks in Fresno and Redding recently. So I think those are moving in the right direction. So, like the secretary said, we've really done a great job ramping up our hiring events and our media campaign. Through the help of Lindsay and her team, we're getting the word out. Many of our homes, once you drive by the fence, you'll see a giant banner that says, we're hiring or you'll see some sort of an advertisement on Facebook.

We are doing everything we can to get folks in, and as the Boss said, we're accelerating the process. Well, accelerating the process means doing onsite scoring and interviews and testing and how to get a job and those types of things. So I think it seems to be working. And of course, we do have to rely sometimes on the registry, but I'm hoping that we're heading in the right direction and we're doing all of the right things right now, and I feel pretty good about it, actually.

Okay, great.

I hope that answers your question.

Yes, and I'd love to just kind of continue to be updated on the Fresno issue. For me, the workforce issue is big. I'm trying to work during this legislative session to figure out what we can do to increase that pipeline, because it's not just, and this was the first time I hear that that's also a challenge that you guys are experiencing, we're seeing at hospitals across the state.

So it's going to be important that we really laser focus on that workforce development piece so that we have every single whole home staffed because the need is great.

Right.

You mentioned there are waitlist.

Absolutely.

We need to figure out every possible way to create that pipeline so that we don't have people waiting when there's beds there.

That's the saddest thing.

Absolutely.

Absolutely.

I want to really keep on this issue and figure out how we can work together to build that.

Yes, ma'am.

Moving forward.

Absolutely.

A couple of other just questions that I had. Obviously, master plans are great, and I think, like you said, it really has put forward the footprint and that you guys are going to continue to build on that to really see the continued change in the Department and in the homes. But I'm wondering, what specific recommendations have you guys implemented of the master plan, or how are you guys doing so and can you do it within the budget that you guys are given?

Sure. I can speak to that. The 2020 master plan came out in 2020. Probably didn't need to say that. Came out in January of 2020. Maybe that's what I should have said. And was a company with some budget change proposals to be able to start the implementation process. So we appreciate the support from the Legislature to get those BCPs through. So we were able to change some of the levels of care again, particularly in Yountville and Barstow. Those were the two key homes from the report.

We changed some of the levels of care, and we moved forward with funding for the new skilled nursing facility. We also expanded our behavioral health staffing in the homes because we saw that as a growing need, that it's going to be a greater need in the future. But we knew we're at least kind of coming into a hump right now. Those items, we got funding for those through the Legislature. So again, appreciate that support from those legislators. So we are in the process of implementing those.

So each of those items takes time. So the skilled nurse facility, it's going to be, I think construction finishes sometime next year, I believe, and the levels of care changes, that takes several years because we're not discharging anyone as part of it. So we have to kind of slowly draw down and then move residents around.

So a lot of those are going to be implemented right around the time the 2025 master plan comes out, in which case we can then kind of look at what some of those next steps are. But again, right now we have what we need to implement those key provisions from the master plan.

Perfect. Thank you for that. And then just to follow up, you mentioned that every home has their own master plan, right? Kind of like more specific. Just wondering, what's the status on the Fresno report? I represent Fresno county as part of my district.

Yeah. So each facility has, it's based on a rotating schedule per law, and the first two that came up were Barstow and Yountville. It's based around when the home was opened. Sorry, Barstool and Yountville. Did I say Fresno? The Fresno home is going to be due in 2028 because that home is still relatively new, each facility, because they're partially funded by federal funds, we can't make significant changes to it within 20 years.

So for the newer homes, the law built in a delay for the first reports for them because we can't change too much yet. But again, that one's going to be in 2028, and then each home is going to be rotating again every five years after their first report comes out.

So the process starts in 2028 or.

The document will be adopted.

The document is adopted in 2028. We start the process a year and a half. Yeah, about a year and a half before we actually would produce it. So that's kind of when the stakeholder process starts and we start doing more of the specific site assessments.

And then maybe if you can just briefly explain what is that stakeholder process look like.

Sure. Yes. We tailor a little bit to the area, but we try to make sure that we have, first and foremost, we want to make sure we meet with the residents so we have resident town halls. We meet with the allied councils, which is the elected body of the residents. We also meet with our staff and get their feedback, and we schedule meetings with elected representatives, state, federal, local, and solicit their feedback.

So we try to have a presentation on this is the current state that we see. These are some ideas that we're thinking of. Tell us what we're missing, basically, and then we take that, we capture it. And so if you've seen our Barstow and Yountville reports, we have chapters dedicated just to the stakeholder feedback. Our goal is even if it's not something we agree with, even if it's something that's not possible, we want to at least make sure it's reflected because I think stakeholders deserve that.

And so again, we have chapters dedicated just to that in each of those reports.

Great. Thank you. I think we're going to move on to. Are there any questions from the members? Perfect. So thank you so much, gentlemen. We're going to move on to the next part of the agenda, which is the new programs and initiatives.

Good afternoon. I'm Keith Boylan, deputy secretary for Veteran Services. I will just jump right in and be brief. I know we're times of the essence here. I did want to just follow back on one of the questions that Assemblymember Valencia had regarding kind of the prioritization of services in the community and kind of what's the best fit. And in talking here today, I've heard that the terms philosophy and as well as community used several times.

I think it's important to really point out that that's something we're very proud of at the department, is something we've really pushed forward with our philosophy in terms of the way we see service within the state.

The secretary alluded it to it when he talked about the cradle to grave, but generally it's more of a life cycle concept for the veterans, from even pre-enlistment till the moment when they're, as the secretary said, memorialized at one of our veteran cemeteries and everywhere in between and truly being there at those moments that matter, we've realized really early, I know in my own personal experience coming up through the nonprofit community in San Francisco, the department, back when I preceded the secretary by a few years, when I got there, it certainly had its challenges, but one of its biggest challenges was thinking it needed to be all things to all veterans, and that was really a big challenge.

So when you talk about prioritization within the community of what service needs, I think we're in a great place now with that community based system of care that we really lead and also have constructed in all of your communities to really depending on that community, really identify where those gaps in service are in that particular need for that particularly community is and address them very effectively and in a very focused way now. So I hope that helps.

As I said, Keith Boylan, deputy secretary of Veterans Services many of the things the secretary talked about fall under my purview, including state cemeteries, all the compensation and pension for the state, as well as C-SAVE, state approved agency for veterans education, as well as a lot of other programs. But we are here today to talk about two of our newest and the latest and greatest programs that we're very excited about.

Within our space, we've been very fortunate, or I'm not sure if it's fortunate, but within the veteran community, many of our priorities align with the rest of California and the concept of California for all. And we've been three of the major ones that have been an issue that we've been addressing very directly, and the administration has as well. Three are housing, mental health, and our aging veteran population. And both of these programs really address all three of those areas. So we're really excited about them.

The first is the California Veteran Health Initiative. This is a concept when the governor came to the secretary last Veterans Day and really wanted to see something that addresses the issue of suicide among the veteran population within the State of California. So we went to the drawing board and put together what's called the California Veteran Health Initiative. As you can see, suicide is not in the name of the program, and that was purposeful.

Much of what we're doing at the department in all our ways, whether it's the master plan for the homes and so forth, is really changing our philosophy, understanding that we can't be all things to veterans and that we need to enlist the community based system of care and work better with our other state agencies as well as our federal partners.

But more so, really identify and look upstream and really try to be there at these moments that matter for these veterans and their transition, at whatever point that is in their life that really provides that. And that was our approach for this program. Suicide is death by suicide is an outcome, but we really felt it necessary to really engage in those moments well upstream that if properly addressed at those times, perhaps would lead to very different outcomes. So much of the program is based on that.

The governor gave us $50 million to establish this program. Unheard of, unheard of support for such a program anywhere in the country. The CVHI will deliver comprehensive, a coordinated statewide approach focused on prevention, early intervention, and direct services to combat, as I said, the risk factors associated with suicidal ideation. The program itself is composed of three main areas. The first piece is outreach, education, and advocacy. The centerpiece is preventative and supportive services.

And then the last piece being surveillance, research, and evaluation between those three parts, and obviously the backside of it, understanding the who, what, where, when, why and hows of that through the surveillance, research, and evaluation side of it, will really help inform our outreach and education and advocacy on the front end, as well as any future policy directions in terms of how to address this tragedy among all populations. But veterans are obviously disproportionately represented in this issue.

As far as an update on that, the CBSI technical assistance grant, this is the will go out. It's gone out through eprocure, through the statewide's procurement system that is currently out and available. The awardee of that contract will assist the department in developing a variety of different parts of this, but more so helping us manage the service providers that are funded through this grant. The middle piece of the grant. The purpose behind it is to really try to build a network.

As I said before, we've really been very successful in developing a community based system of care that works very closely with the department now and through that. This is just another pillar of service in mental health, specifically that we're trying to build out now. So part of that is just increasing those folks that are already in communities doing great work.

For instance, when I worked in San Francisco at Swords to Plowshares, I was in a legal unit that we had a United Way Grant, and that grant only allowed us to provide legal services for folks in San Francisco if someone calls from Alameda or Contra Costa or so forth. Although I may have the time and abilities by the details of the grant, I was unable to provide those services.

So organizations like that, this will be able to make them increase their catchment area or perhaps bring on additional staff to provide more sessions available within their regular hours. Additionally, this will be able to look at folks like Nami, the Cohen veteran clinics, and a variety of others that really have a community of network providers throughout the state already to get them more versed in providing veteran specific mental health treatment, as well as telehealth throughout the state as well.

So really trying to be representative and make sure, obviously, the push and pull factors around death by suicide are very different. When you look at a senior veteran up north, rural California, versus perhaps a 28 year old in skid row in LA, the reasons and the complications and barriers around that are very different.

So we're hoping that we have a good influx and a good representation of the entire state, but then also with providers that are able to provide whatever that level of care, whether it be basic peer support and socialization all the way up to high acuity and everywhere in between. So, really excited about that program. Unless if anyone has any questions specifically about CVHI, I can move on to VSSR. Or do you want to just do that now and we'll circle.

I just had a quick question. In terms of the network of clinics that you just spoke about, how would that work and how do you identify where those clinics would be geographically? Obviously, you mentioned there's a difference, right, between rural and some of the urban.

Sure. And that's always the challenge. When you look at the rural community, that footprint of that community based system of care is usually very limited. I mean, underrepresented communities are often underrepresented for a reason, and that's because that network is not there. We experienced the same thing when we rolled out our veterans housing and homeless prevention program or any of our programs for that matter. So that's always in the back of our heads about how we increase that.

There's a variety of different entities that we'll be working with that actually find community providers, and these can be private providers as well, to work through the nonprofit and provide those services in that area. Oftentimes it's very difficult. It takes a lot of detail, for instance, getting applications to come in for our VHHP program, LA, there was no know. The developers and everybody were very coordinated. They understood how to put together the application and so forth.

When you get to the rural communities, it takes a lot of technical assistance. You need to go out, you need to have a lot of community gatherings. You need to get folks in the room. You need to make sure all the right people are there. You really need to hold some hands and help them across the finish line and help them participate in the program. So that'll all be part of it as we move forward.

Some of that will be managed, I think, in some way by telehealth on some level. But what we've seen coming out of the pandemic, it was an effective use of Zoom and so forth during that time period. But folks, perhaps that initial, the data that I've seen coming back, the initial appointments, people still prefer to be in person, perhaps follow ups, when you're comfortable with a counselor, are more accessible through Zoom, and folks are more of their comfort levels a little higher at that point.

But those initial moments, it's really important to have some in the community that's there for them and able to take them in person. So that will certainly be one of the challenges that we will face with this. But we have a lot of great people involved that are well versed in this world. So we're very excited about the opportunity.

And I think also one big part of that is similarly, when I first came in back in 2013, I think the VA at the time had a backlog of compensation and pension claims of nearly 70,000. So Governor Brown, at the time the administration, supported me in getting 36 positions to basically go into the district offices that I have throughout the state that are colocated in the federal VA regional offices and sit down with these backlog claims.

So I had 36 state employees basically doing this federal job, but obviously for California veterans, so we couldn't not help. So fortunately, the administration was amazing in supporting that effort, and we got in. And in 26 months, I think it was, we brought it from 70,000 down to 6000. So it was a tremendous effort.

But one of the things that really came out of that, that was kind of an unexpected consequence, was our relationship with the counties that I oversee all the claims work for all the counties in California, as well as our new access to the federal world and how they operate on a day to day basis.

Being involved in that kind of scene behind the curtain allowed us to connect so many other strands of our business and processes and procedures and understand how the counties worked and understand how the state worked better. I mean, how the feds worked better. And when we came out of there, not only did we solve the backlog problem, but we really laid out a new framework for communication with our partners on a federal to community level process and procedures and everything else.

And when I say a network of mental health providers, part of it will be building this community that has more robust, more sessions available in every community, ideally, but it will also be a big part of that will be the connectivity between these organizations within their communities to understand who's doing what within their own community and understanding that they're part of a community based system of care. Oftentimes, particularly in the veteran space, you'll have an individual seeking a grant.

That grant comes to them and they feel like it's them and their grant against the world when there might be folks not very far away in a similar situation that collectively their sum is much greater than their parts. So with that, and then within the communities moving forward with that connectivity, they'll also have some increased opportunities for some county support in terms of the county mental health programs collectively. Sure.

Do you want to move on to the next? Unless there are other questions.

The second program is the Veteran Support for Self Reliance program. VSSR, the acronyms. And you guys, I know some of you are new to the committee, so we look forward to working with you. And myself and my staff are always available. We can make a cheat sheet for acronyms if necessary. All the programs have numerous, but the Veteran Support for Self Reliance, really neat. It's a pilot program that we were funded $25 million to put it out for three years.

And the concept of the program is to really go into permanent supportive housing and support those veterans that are either senior or have high acuity needs. And the idea behind it is the folks that are in permanent supportive housing under a Hudvash voucher. This money will allow folks to providers to hire up additional personnel to provide a more robust, increased level of supportive service for these folks while they're in there.

The idea behind it is to increase the stability of the housing among these populations and obviously their overall wellness as well. The pilot is just kicking off. We just did the first round of grants. We had every. Back to your question, ma'am. We had every region within the state except the Central Coast and Central Valley represented in this program. That was a challenge, and we shopped hard for grant applications in both those locations. We do have San Diego, we do have LA.

We have the Inland Empire. We have Sonoma, Sacramento, San Francisco, but unfortunately not represented in the central part of the state, which is an ongoing challenge. However, through this program about, there'll be just over 700 veterans that take part in the pilot program. As I said, each of those organizations will be provided additional funding to bring on additional staff, mental health specialists, peer support specialists, social workers, registered nurses, occupational therapists, service assistants.

This kind of goes back to the philosophy in the department, which has changed dramatically under the secretary's time there, which our programs, as we heard about the homes, we really look at all of this is what, in this cradle to grave concept housing is obviously one part and that continuum of housing is another part. What kind of programs does the department offer in that whole continuum of housing? And we have long term care. Teresa Gunn's program offers our farm and home loan program.

There are some additional sweat equity aspects to that as well that we're very proud of. And then when you get into the veteran services, we get into my space, which is more permanent supportive housing, transitional housing just shy of affordable housing, but additionally housing with wraparound services in that aspect. So we're really excited, ideally, when this is all said and done, assuming that the results are what we would expect them to be, a wonderful success.

The push will then will be to the Federal Government in asking the federal VA to really consider an expansion of their Hudvash program to start looking at really making the case management services and supportive services that go along with our Hudvash vouchers much more robust considering the population and the barriers that population has.

Just one clarification, This VSSR program is geared towards seniors. And what other veteran population?

The high acuity veterans who have a larger issue, health care issues. Sure. And I think it's important, too. I mean, it's short of a skilled nursing facility. There's this really, this in Department of Aging, we've worked really closely with them.

They were just presented at their director and several others in the creators of the master plan presented our conference, our leadership conference we had down at San Diego, because Department of Aging is really interested in seeing how this model works, because obviously veterans are just a subset of the population, but in theory, if this works for the veteran population, it's certainly scalable to the larger population because there is this, in particular, this is permanent supportive housing.

So these are people that generally don't have family in place. But a lot of the services that will be provided to these folks are those things that a family member would generally take care of, whether it's bathing and cleaning the apartment. A lot of senior veterans are evicted for hoarding issues and other connected mental health challenges. So it'll be addressing all of those medication management, those kind of things.

Great. Thank you for that. The only thing that I wanted to follow up, because you did mention that the Central Valley wasn't represented. What can we do to address some of the challenges? Are you guys looking at doing anything to ensure that when there's these types of opportunities, that some of these communities that are much more disadvantaged aren't left?

It's hard. It's hard. This one in particular was a little more difficult because you had to be able to. There's an organization called down there, CAVAF, that's a Member of the CAVSA organization, which is a California Association of Veteran Service Agencies, which are all the kind of the big veteran specific ones throughout the state. There is a representative of them in Bakersfield, but unfortunately, they weren't able to, for a variety of reasons, participate in this just because of things they have going on their lift.

And short of them in that Central Valley area, there's really none that have the size enough to be part, because it is a pilot program. So all things kind of need to be equal among the grantees in order to make sure the outcomes are significant and are provable. So it was very difficult in this particular situation to deal with folks that might have eight folks only in their permanent supportive housing because we needed each of them.

Each of them average about 123 residents within their program that will be part of the pilot. So scale wise, Central Valley really only had one option, and that option wasn't able to take part. So that really made it difficult. We considered trying to do maybe 5-6 sites, but even with that, when you bring on additional employees, like, say you bring on a registered nurse, that registered nurse at that point now has to go to six different sites.

And then you start questioning, did those folks receive the same level of care that the folks that are all housed at one site where those employees were able to show up for that entire amount of time at the same facility and so forth? So then you start having to adjust perhaps the data on the backside based on some of those factors. So we tried to keep it as apples to apples as possible. And unfortunately, in the Central Valley, that just wasn't possible without VAF's participation.

So the density was the factor.

Certainly.

Certainly.

Okay.

Perfect. Thank you for that.

Sure.

No other questions from the members. So I'd like to offer an opportunity. I don't know if there's anyone from the public that has any questions or comments. The time is now.

Good afternoon. Good evening. Chair and Members. Seth Reed with Reeve Government Relations. Just real quick. Thank you, Dr. Vito. It's been incredible to be able to work with you. I started in 2017 doing this work, so I started right around the same time, and it's been wonderful working with him and the team. So thank you very much. Thanks me and my clients.

Thank you.

Mr. Secretary.

I thought. Just occurred to me that Kobe mentioned that we have these signs outside our veterans home just hiring. Now. I've got that same sign hanging outside my window.

Well, thank you so much for that comment. We'll make notes, but I did want to just sincerely thank the secretary. Obviously, your tenure and the remarkable work that you've done along with. Obviously, it takes a team to get to where you guys are all at. And so I'm looking forward to continuing to work with you. Obviously wish you well in your next chapter, knowing, though, that you've really developed some good infrastructure so that we can continue to move the department in a positive direction.

So thank you so much for being here today.

I certainly appreciate your remarks directed at me personally, but I really think that this exercise that we've been engaged in, Calvette, just as proof of that good government works, because it was collaborative with the Legislature and our Boss, and I'm very proud that this was a collaborative effort. I certainly could not have done this by myself.

Absolutely. Thank you so much again to all the presenters today. Appreciate all the information and looking forward to working with you guys at this legislative session. And, yeah, so thank you for being here.

Thank you.

And we will be adjourning this meeting or the hearing for today. Thank you.