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State Seeks More Federal Money For Veterans’ Nursing Home

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An "incorrect interpretation" of strict federal design guidelines for a planned state veterans' nursing home may drive up the project's costs by more than $20 million.

Gov. Rick Scott and the Cabinet will be told today that the cost for the St. Lucie County facility they approved in 2014 is projected to grow from $39.7 million to nearly $60 million because of federal guidelines that were not in place when the state first looked at building additional veterans' nursing homes across Florida.

The need to change the St. Lucie facility's design, which includes additional square-foot requirements, hasn't delayed the project. But Colleen Krepstekies, director of legislative and Cabinet affairs for the state Department of Veterans' Affairs, said the state awaits guidance from the federal government.

"We're in a waiting pattern right now," she said after addressing Cabinet aides Wednesday.

Florida Department of Veterans' Affairs Executive Director Mike Prendergast wrote to U.S. Department of Veterans Affairs Secretary Robert McDonald on March 3 and said the state agency may have to redo its grant request for the 120-bed facility in St. Lucie County unless the federal agency can agree to some compromises, from waiving design requirements to agreeing to cover at least 65 percent of the added costs.

"Our analysis has revealed that the (Community Living Centers) design guide standards pose significant human resource, financial and fiscal challenges for states that have previously submitted grants for nursing homes," Prendergast wrote.

The 65 percent mark is what the federal government agreed to cover when Florida sought a grant for the facility at $39.7 million. The state is expected to pay $13.9 million of that cost.

Prendergast noted that without the assurance of additional federal money, the state Legislature "will not increase funding to this or any other construction projects."

In the letter, Prendergast noted that the state in 2011 submitted plans to build four conventional nursing homes, a year before the federal agency set new Community Living Centers designs.

Prendergast said in the letter that there wasn't a fiscal analysis when the new regulations were adopted nor any formal notification that states would have to follow the new standards.

Prendergast's letter seeking "relief from an incorrect interpretation" of the design guide, came a week after state and federal officials met to discuss the issue.

The federal standards require one nurse per seven residents. The state was working on a ratio of one nurse per eight residents, in accordance with Medicaid and Medicare and Florida Agency for Health Care Administration requirements.

Krepstekies, after addressing Cabinet aides Wednesday, said the federal standards require a number of private rooms, which will increase the footprint of the 28-acre facility that has been named the Ardie R. Copas State Veterans' Home in Tradition.

Copas, a Medal of Honor recipient from Fort Pierce, was killed during the Vietnam War.

Prendergast said in the letter that as the footprint is stretched, operational costs grow.

"For example, air handling units must be provided on a one per neighborhood basis," Prendergast wrote. "The more neighborhoods you have, the more mechanical equipment is required."