 this is Think Tech Hawaii military in Hawaii on a given Thursday with Thomas Trisco and he's with the what the Veterans Affairs Department here in Hawaii and he is overseeing the completion of the Veterans Health Center out in Kapolei. Very important project. It's the Daniel K. Daniel K. Akaka. What veterans? State veterans home. State veterans home. Veterans home. Right. Thomas, so what is going on? Is it just about finished now? Oh, hey Jay. Thank you. I appreciate the opportunity to speak with you. 50% is where we are with the actual construction of the facility. We broke ground in April of 2021 and we're scheduled to finish the construction portion of it in April 2023. So we're moving forward and there'll be some follow on actions that'll take place once beneficial occupancy is obtained. How did this all get started? Was the Daniel in Hawaii involved? Was the Daniel Akaka involved? Always involved. Always involved. He was everywhere. You know, God bless him. I'm blessed to be able to have worked with him in the in the years past. That's actually a long question. I mean, I'll try and give you an abbreviated short answer. Yeah, if I'm detailing it too much, just, you know, throw a rock at me through the screen. I've been blessed in my career to have a number of different positions and one of them was the president, first president CEO of the White Hill Systems Corporation. We'll call it HHSC. That's our state hospital corporation, if you would. And I was there from 97 to 10. And during that time, we did a number of different things. One of them was we opened a VA clinic in Hilo at the Hilo Medical Center. And Senator Dan Patsy-Meg, Senator Kaka, whole group of them all came over for this opening dedication, if you would. Now, Jay, you've been in Hawaii a long time. So you can reflect back to Hilo driving up the hill there and you look on the right and you see the beginning of a hospital. And then you used to see a huge old building with trees growing out the center where the earthquake cracked it, and then the rest of the medical center. And that's what we had. It was not only dangerous, it was a real eyesore and it just took away from all the goodness that was taking place. Now, I made a statement about how little priority this issue was given. Oh, yeah. Yeah. You're absolutely right, Jay. The legislators came over for that clinic dedication, which was in a medical office building. And I walked them over. We looked at that. We had the chair of my board die-in plots with us. And we all agreed, we got to do something. But let's do something meaningful. Okay. State Veterans Home, it's a system of facilities that was started after the Civil War here in the United States. And there are 159 of them right now. Back in the early twos, there were about 140, 135, I guess. And Hawaii didn't have one. And we said, you know, maybe this is our opportunity. And the legislators fell in on that. They supported the initiative. They talked to the state legislators. It's a process. The details don't matter. But what does matter is that in the process, we learned that if you don't have a state veteran's home and you can get it approved and funded, you go to the top of the list. And we did. And our legislature came through. It's a federal state sharing 65-35 type of thing. And we open that home now. We're talking about Hilo. Where are the veterans in Hawaii? Well, they're all over Hawaii. It's 117,000 of them based on the 2020 census. But 85,000 of them are on Oahu. I made a special trip to Oahu Veterans Council. And I said, look, we got to do this in Hilo for a whole lot of different reasons. It'll be open to everybody, but we really need to fix that situation over there and make something available in Neighbor Islands. Remember, Oahu gets everything. The Neighbor Islands get very little. That's actually true. Oh, it is true in so many ways. But I said, look, I'll make a commitment to all of you, ladies and gentlemen. If you'll support us, put first home in Hilo, I'll do everything in my power to bring the second home here to Oahu. And they agreed. And they did. They fell in. No opposition. Well, it's a long, arduous process, but we started back in 2012. The current director of the state office of veteran services, Ron Hahn, and I started. And it's a whole story into itself. And I won't belabor the point. Suffice to say, after trials, tribulations, and more bumps in the road than I'd ever like to remember or think about, this program carried all the way through to get the full funding shared by the state and shared by the federal authorities. And so here we are, breaking ground, moving forward. And it's happening here. Have you been at the point of this from back when? Initially, I was at the point. But when I retired from my position as president of HHSC, I immediately went to work for an organization called the VA Pacific Island Health Care Program. And that's the formal federal VA here in Hawaii. And they have clinics all over Hawaii, American Samoa, Saipan, and Guam. And I was overseeing the clinics and doing some other work with them, too, on rural health and so forth. As a federal employee, I was very limited in what I could do. I could give advice and opinions, and especially in terms of lobbying. But I pushed the margin. Ron took the lead. We worked it through a number of other people fell in to include people at HHSC and legislators. And it's a long story, like I say, of funding and bid protest. Oh, no, no, no. You name it. Okay, so one thing that troubles me is that you know, this problem, this gap, call it a gap, in terms of care for veterans has existed for a long time. And you know, there's been, I mean, demographically, we have provided we are home to an enormous number percentage wise of veterans in the state of Hawaii. So here's the question. See what you can do with it. How come it took so long? Well, hey, Jay, that's a great question. It really is. And I can only give you my personal answer. I can't give you an institutional answer. But I'll tell you, I served 29 years in an army. Once you're in an army, you're always in the army. I was taking care of veterans in the army. I was a chief of staff at Tripler 92 to 95. Tripler is the veterans hospital. Okay. Now, in my work at HHSC, we had, I had a neighbor Allen orientation. We had ultimately 15 facilities and 12 of them were on the neighbor islands. So my, my role at HHSC was to focus and bring forth capacity on the neighbor islands. My personal bound of the whole thing was as a veteran, let's do something for the veterans, all of the veterans in Hawaii, but let's focus on neighbor Allen. So prior to the Hilo event, no one had ever discussed this, this, this special offering. A lot of work has been done by the Fed. I mean, a tremendous increases. The VA Pacific Allen healthcare system has grown from a little bitty clinic down in the old government building downtown to now having prowess and CBOX clinical outpatient based clinics all over Hawaii. I mean, they're growing, they've just opened a new clinic in the, in the westward side. Are they dedicated, dedicated to veterans, these clinics? Yes. Yes, sir. And so I think the answer to your question is multifaceted. It's got a state veterans home component that I've just tried to convey to you, but it's also got the federal component and the Fed has done a lot and continues to do a lot more. VA Pacific Allen healthcare is growing like crazy. In capital A, we're building this 120 bed facility right out there near the Walmart. Couple of blocks away, the VA Pacific Allen healthcare system is put in a mega clinic right there in capital A with not just primary care, but mental health and specialty care. And so that's, that's part of the formula. It's a combination of those things. It sounds like a reorganization is what it is, you know, in essence. But what in Hilo is that going to continue? Is that being upgraded? It is continuing. It's, it's actually, it was a state of the art facility when it was built. As far as the facility itself goes, it's a profitable operation and they put their money back into it to maintain it and keep it going. It's suffered. I mean, it's, there's a sad story from the pandemic with Hilo and it suffered and a number of veterans passed away over there and there were staffing issues, but it's coming back now and it's doing, it's doing very well. There are staffing challenges today still in Hilo. The bed capacity is 95 beds. It's not back up to its full bed capacity yet, but it's there and it's doing a great job and it's coming back. So the 65-35 split, what's the cost of the one now in Kapolei? If I take the 65, I guess that's federal and 35 state, what am I talking about? 100 million, 200 million, what? Well, you know, I'm waiting in a minute or two. You're going to ask me an easy question. So that's a hard ball question. I never promised you a rose garden time. I got it and you probably didn't intend it that way. The overarching answer is this is a 98.4 million dollar facility in total program package. Okay. Now, indeed, this program, state veteran terms is a 65-35. It's a wonderful deal for every state because the fed's kicking in 65% of the whole enchilada. It's great. Okay. Unfortunately, in our case, we got all the approvals to go forward. We got the legislative split, the guarantee on the 35%, and everything lock loaded, ready to go. And the construction contracts put out, awards made, and it fell into a very challenging bid protest problem. It drug on for a year and it drug into the pandemic. And without recounting all of that aspect of it, I know you recall, there was a period of time when our state was looking at a $1.4 billion deficit as to how we were going to manage. Not too long ago. If it wasn't. And it's right in that period of time that the protest was completed and we're trying to pull the funds out. And of course, the state is trying to survive. So any funds available are really being... Bottom line is it didn't get started. The notice to proceed didn't get put out there because the funding wasn't available on time. And that raised the cost of this thing. So ultimately, the split is more about 55% state and 45% federal because... Oh, it's too bad. So we have, relatively speaking, we've lost our federal funding to some extent. Well, we actually... Let me try and say that same thing you just said, but say it a little differently. We actually didn't dollar for dollar lose federal funding. What happened was we were eclipsed by the inflationary cost of the delay. And the only way we could open this home, we had to go back to the Hawaii State Legislature for another $26 million, which blessed their hearts. And I won't name legislators because that gets into political. But a number of legislators came to bet that we're able to secure the additional $26 million. And that's when the final approval to start work was put forth. Well, just another example of how COVID has disturbed and disrupted things. Let me go to... The final result is going to be this 120-bed facility for veterans. And right now, in Oahu, there is no such thing. So this will feed a gaping need. It'll also take the pressure off of Tripler, I guess. As you said, Tripler is the go-to place for veterans. And although I suppose veterans will still be entitled to care at Tripler, the new facility will help take the pressure off Tripler. Am I right about all that? Your concepts are right on. You have much insight into this work. I can see that. Let me modify that just a tad, if I could. But you're right on spot. Tripler is an acute care hospital. It does not have a long-term care capability. However, just like Queens or Capilani or Palimoni, you don't need me to name them all, our acute care hospitals here in Hawaii are all over Hawaii treating veterans. Tripler is the go-to hospital for veterans. That's true. However, in recent years, over the last five, six years, VA has begun to offer choice to veterans so that veterans no longer have to go to a VA clinic. They don't have to go to Tripler. They have choice. And so we see veterans in all of our hospitals. But now here's where the real beauty of this comes in. Back when I was at HHSC, I worked with the Health Care Association of Hawaii. I was chair of the board for four years there. And our biggest problem then, and one of, if not the biggest problems now was called waitlist. We have acute care beds filled with patients who are no longer acute. The ability to bring that patient in, stabilize them, and then move them to a post-acute care facility is a huge challenge here in Hawaii. That's where this is really going to help. It'll help Tripler, but it'll help everybody, and especially will it help because we're going to have a lot of memory care capability. The most difficult patients to place out of an acute care hospital are those who are no longer acute. They still require long-term care, daily activities, et cetera. But when you overlay that with the memory dementia Alzheimer's, yeah. It's so tragic because you're really not able to take care of themselves on the outside. Yes, sir. And understandably, those patients are very expensive to deal with, and the nursing homes, by and large, either can't always deal with them or don't want to deal with them. So this will really help all of the healthcare system here in Hawaii with that waitlist issue. Just like you described with Tripler also, though, it'll help all of them, yes. But this is a senior facility, a care home. 120 is actually, you say 120 beds, but what about the people who don't require beds? Do you know what I mean? People who live in a care home, and they're able to function and take any number of civilian care homes in the state. I suppose you could actually accommodate more than 120, but even that, even if you double that, just for this discussion, there's a lot more veterans that are aging in the pipeline who are here. And some of them have had economic problems, there are a lot of them, may I say this and I hate to say it, a lot of them on the street right now today, homeless and drugs and poverty and very tragic because they put their lives on the line when they were in the service, and now we can't really take care of them as tragic. So the question is, what happens to the ones that go beyond the capacity of the Daniel K care home? What happens to them? Is this going to handle them or will there be a continuing problem? I think it's an evolving problem. I hate to say continuing, but I'd have to agree with you that it is a challenge that we face now and we'll face it in the future. What happens? There's a handshake, a partnership that's taking place here that deals with this issue you just mentioned. Now, Daniel K Acock, a state veteran's home, is one component of the relief valve. Let's call it that. I can't say solution because that implies it'll fix it, but it's part of it's one part that it'll be one partner in the relief valve. When I went to work for VA Pacific Island healthcare system, they had a homeless section run by a social worker. He had three people. Okay, I retired from there after eight years and when I retired, there were 53 people working in that same session section. Huge outreach. There's a lot of affordable housing. There's special veteran homeless housing in capital A. All these things have been are being developed and are further maturing and don't forget the city and county, you know, and all their efforts. There's a lot of teamwork taking place. So it's not just the state veterans home. It's this partnership. Not all of the people that you and I are speaking about would be candidates for this state veterans home because you have to be, you have to need long-term care and that's measured in terms of your daily activities and what you can and can't do plus your other medical overlying conditions. But some of the people you mentioned will be candidates for the home and they will come into this home. Others will be dealt with through some of the other mechanisms that are being put in place, but it's an ongoing challenge for us. It really is and it's a lot of resources are being put against it. I think a lot more will be in the future. Well, on that very point seems to me that you're going to find that there are a lot of veterans here that that could qualify. And as as the, you know, the demographic gets older, there'll be more. I mean, that's the way it works. And people live longer because of modern medicine is more people will qualify and 120 beds or whatever the total capacity is may not handle it. So at that point, somebody maybe you I'm going to have to decide that you need another one or you're going to expand this by double or triple. So to, you know, have a reasonably humane response, you know, to the changing demographic, right? You know, if we're not careful, somebody's going to think that you and I spoke before this interview. And we didn't folks. Okay. The first time I met Jay is on the TV right here. Yes, you're absolutely correct. Two things. Number one, I mentioned there are 159 state veterans homes in the system nationally. Three of those have adult daycare. Three. Okay. This facility is going to have adult daycare. Now we won't have it when it opens because that's a that's a second step. And it will be part of our as we move to max our census, and it will open up probably about year two or two year three. But we will have adult daycare and that will help. Okay, that's that's a piece of it. But to your point, every state in the country based on the VAs, they call it vet pop veteran population, every state in the country is authorized a specific number of state veteran home beds. And the number is important because that's the number the VA pays a significant per diem for veterans who are in a state veterans home, especially if they're 70% or more service connected disabled. So that number is important. Our number here in Hawaii is 268. We use 95 beds in Hilo. We feel bigger gap here with 120 beds on Oahu that leaves 53 beds we still have an authorization for. And we've already begun our inroads and I'm not prepared today nor would it be appropriate for me to say where the next one's going to be, but it's going to be on neighbor island. And you can probably figure that out. Well, that'd be appropriate really. But you know, what you mentioned in connection with Hilo that one of the issues they've had in recent years is a staffing issue. Right. And I wanted to ask you, I'm sure you're working on this, how do you staff and facility out there, the Daniel K Kaka, you know, home, how do you staff that with doctors and with non, you know, with, you know, nursing and all the things, all the people you got to get when already there's an issue about qualified people. Yeah, it's that's another great question. The beauty of this is the location and the proximity in the new city. There are many qualified, potential healthcare providers. And I mean every, I don't just mean doctors and nurses. I mean, licensed practical nurses, nurse assistants, dietitians, physical therapy, you name it. Where do you get them? Are they federal employees? Are they existing federal employees? Do they come from the mainland? Do you have to hire non federal employees and make them federal employees? How do you feel the ranks? Sure. It's confusing. And I know I just to properly answer this because I got a front piece and a second piece now to properly answer your question. First off, all there are no federal employees in this facility. It's a state facility. Now in our case, just as in Hilo, they will not with the exception of two liaison personnel, the employees at this facility will be contract managed employees. Same way we did it in Hilo. Okay. Now in terms of the who and I mentioned capital A because there are a lot of folks out there who just can't put up or refuse to put up with that turmoil of drive back and forth to reach a destination where they can employ their trade. There's a pent up demand in capital A for this facility for an array of healthcare providers from nurses, not so many doctors in a facility like this, but a lot of nurses, nurse assistants and LPNs will be able to draw from that community, people who currently are capable and credentialed to do this work, but currently are not employed in the healthcare arena. Now, sure, there, you know, it's, there'll be some movement from the other hospitals, but that's, we don't want to take patients. I'm sorry, we don't want to take staff from other hospitals. We want to develop our own base. And so the second piece of all that is the relationships we're establishing with a community college, John A. Burns School of Medicine, the various geriatric fellowships throughout the state, where we're going to be a practical platform for rotations of all those students and establish that relationship. We will help those programs by offering those rotations that will enhance the programs. And not only that, it will expose those various participants to a state veterans home that'll be a brand new experience for them. And lastly, there is a network of state veterans homes, as I say throughout the country, that, you know, share information and so forth. But, but we focus local. That's where our focus is local. Yeah, UH nursing school just got a new dean, I think. And so there's sort of be a great interest to them because there are lots of jobs awaiting them. Their problem is not so much placing their graduates. Their problem is getting people to come to school in the first place. I don't understand that because I think nursing is a great career. But that, you know, this is probably a nationwide issue about finding people who will study nursing and be nurses. Oh, it is, it is. And I'm also on the board of the university health partners, the previous. It's the practice plan, if you would, for the university of Hawaii. The dean of the nursing school is on that board. And I have all of the all of the division chiefs for the whole university are on that board. And I share this information. And, you know, they're all involved marginally at this time, but they're all involved in the know of what we're doing and how we're doing it. And everybody's interested in participating. Yeah, now I now I get to my my toughest question. I'm sorry, Thomas, I'm sorry in advance for this question. You know, you talked about the business of senior facilities. And indeed, aside from, you know, the veterans administration, you know, these these care homes around the country everywhere, every state, every community, you know, they're all on the edge. They got to get paid. They can't function without, you know, income. Sometimes they you find little scandals here and there because they don't have enough income and they cut the corners and the people who are in their care may not even realize it. And it takes somebody to come down one day and notice that, you know, the seniors are not being attended to happens all the time. So the ongoing issue is very important to keep this care home, this senior facility, this Daniel K. Kaka senior facility funded. Okay. So we talked about the 98 million. We talked about the split between the state and the Fed. We know that sometimes we know that sometimes veterans affairs are not attended to in Congress, or for that matter in the state ledge. We know that in order to maintain, you know, 29 years in the Army, you know that this finest military force in the world. However, you have got to make them feel the government cares and the people care. You know, the community cares, you got to make them feel that way. That's why this project is so important to make them feel they there's something at the end of the road for them, and to be treated well. And senior years, you know, maybe memory problems, whatever that somebody will take care of. So my question to you is, how can we be sure that the annual expense of running this at whatever, you know, per diem amount of costs per patient? How can we be sure that that will be funded? Is there any issue? Or is there going to be a struggle about that too? Well, if I said, trust me, would that be enough? Okay, gotcha. Then let me assure you, Jay. Here's the here's the picture. State run facilities are not businesses. They're government facilities. They all lose money. And if one of them makes a little bit of money, it just gets sucked up by the other one. So this is not part of that type of system. I mentioned a little earlier that we're going to have a contract management corporation that's going to be operationalizing this facility for us. And I mentioned the employees are not going to be federal. They're not going to be state employees. They're going to be contract employees. Now, for the first point, to really get at that great question, this gives tons of opportunity for filling gaps, all types of work that is not necessarily available for federal or state employees. But as we go forward, more importantly, the state veterans home will bring into Hawaii a conduit of funding that we currently do not enjoy. We enjoy a bit of it in Hilo. And I'll just give you a precise example. If we have a veteran in this home, who is a 70% or greater service connected disability, I'm a 70% disabled veteran myself. So if I'm in that home, that home is going to draw $524 a day under this year's prices per diem for me every day. Now, it's got to cover all my problems, all my costs, all my medical issues, everything else that got to be covered. But that per diem is so high that it allows us to go the extra mile. And it allows us to assure you, Jack, that in combination with the other pays, because we also can pull on Medicaid, as well as Medicare and self pay. When we combine that resource pool together, we're looking at multimillion dollar profitability every year after this facility has stood up. And it's not about profit. Profit is important because, number one, it means we don't ever go back to the state and ask for a dime again. And that's the way it's been in Hilo. We don't go back to the state to ask for money. Number two, by operating on a profitable basis, we give the best of everything to the patients, to the veterans, to those few veteran spouses, and perhaps even some Gold Star parents in there. They're going to get the very, very best of anything and everything that's available. But equally important, that profitability now allows us to continue to reinvest in our facility, to continue to reinvest in our staff, state of the art training, the extra mile, if you would, to ensure that the facility has everything it needs. All of our amortization schedules are set and done right. Equipment is pristine. It's, I mean, it is a wonderful facility. And with the exception of Hilo, there's nothing else in the state of Hawaii government picture that looks anything like this. Very important. All very important on so many levels. I hope we can, you know, circle back with you, Tom, later as it gets closer to completion, as you stand it up and get veterans in it and, you know, make it happen. I really appreciate your effort and your service in this regard as well as in the Army. Thomas Driscoll, standing up the Daniel K. Akaka Senior Care Facility in Kapolei. Thank you so much. Well, thank you, Jack. Your interest is deeply appreciated on behalf of all of our veterans. God bless you, sir. The same. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter, and LinkedIn, and donate to us at thinktechhawaii.com. Mahalo.