AP Photo/Charles Krupa
State-run nursing homes that look after more than half the veterans in the U.S. Department of Veterans Affairs (VA) long-term care system aren’t getting the federal oversight they need, according to a report released this week.
Though the study from the Government Accountability Office (GAO) looked at a period before the coronavirus pandemic, House members in a Wednesday hearing questioned whether the VA’s lack of supervision could have contributed to the death of veterans in the state-run homes. The numbers of infections and deaths at the vast majority of those homes are not publicly available, but nearly 200 veterans died at three homes that experienced severe outbreaks.
“The experience of residents and staff at many of the 157 state-owned and -operated veteran homes nationwide has been starkly different from that of veterans and staff of the 134 community living centers that VA owns and operates,” said Rep. Julia Brownley (D-Calif.), chair of the House Veterans’ Affairs Committee’s health subcommittee.
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She cited a Washington Post article on 30 residents at the Southeastern Veterans’ Center about 30 miles from Philadelphia. They had underlying heart conditions and had not been tested for COVID-19 but were given hydroxychloroquine, a drug known to cause serious heart irregularities.
“The FDA emergency-use authorization that was in effect at the time stressed that the drug should only be administered to COVID-positive patients in hospital settings, not in nursing homes,” Brownley said. “The Southeastern Veterans’ Center lacked the equipment that would have been necessary to provide the FDA-recommended heart monitoring.”
The state homes receive more than $1 billion a year from the VA to care for about 20,000 veterans. Though VA contractors inspect the homes every year, the agency doesn’t share the findings of inspections on its website, something GAO researchers said also needs to change.
Outbreaks hit hard in homes
Since the start of the pandemic, almost 63,000 residents of long-term care homes nationwide have died of COVID-19, according to a Kaiser Family Foundation analysis released Thursday. That number is an undercount because four states don’t report coronavirus fatalities from nursing homes to the Centers for Disease Control and Prevention (CDC), yet it still is more than 40 percent of all deaths.
The number of coronavirus deaths at state veterans homes also isn’t known because the homes don’t have to report them to the VA. Three centers that Brownley cited out of what the GAO says is 148 state veterans homes had nearly 200 deaths: 42 at the Southeastern Veterans’ Center, 81 at the New Jersey Veterans Home at Paramus, and 76 at the Soldiers’ Home in Holyoke, Massachusetts. As of last week, 199 residents out of 336 beds at the New Jersey Veterans Home had COVID-19, a 59 percent infection rate.
VA-owned and -operated community living centers reported only two positive COVID-19 cases out of 7,500 residents, VA Secretary Robert Wilkie said in an interview last week.
‘Who’s in charge?’
When COVID-19 was declared a pandemic, the Veterans Health Administration reached out to state veterans homes to focus on safety and quality care, Teresa Boyd, a physician and the VA’s assistant deputy undersecretary for health for clinical operations, told the committee.
“Even though these homes are state-run facilities, we have always had an open and positive communication with them and maintain a readiness to help, should they require aid,” she said. “We share a common focus and prioritize safe and quality care for our veterans.”
Paul Barabani of the Holyoke Soldiers’ Home Coalition, a grassroots group of family and veterans that formed after coronavirus deaths at the center escalated, contended that the VA did not properly oversee the site after the home’s officials told the VA it did not have an infection-control program.
“It is the coalition’s belief that the lack of sufficient staff and overcrowded rooms were root causes of the rapid spread of the virus, resulting in the death of 76 veterans at the home,” Barabani said. “My thoughts on improving VA oversight of the veterans home would be a much greater collaboration and partnership between the VA and the veterans homes.”
When AARP asked agency officials if they could have prevented coronavirus outbreaks and deaths in state veterans homes, a spokesperson said federal law doesn’t give them authority over a state home.
“In other words, individual states — not the federal Department of Veterans Affairs — are solely responsible for the operation and management of state-run veterans homes and any problems that arise within them,” said Christina Noel, the VA’s press secretary.
Rep. Josh Gottheimer (D-N.J.) criticized the deaths from the known outbreaks in the state veterans homes.
“The question that I have to this committee and those who are testifying, [and] I think we all have a right to ask: Who’s in charge?” he said.
The GAO contends that the VA has a role in overseeing state veterans homes and reiterated three recommendations it made in a July 2019 report:
• Own up to deficiencies. State veterans home inspectors should identify all failures in quality standards as deficiencies, not “recommendations.” VA officials say they don’t monitor whether recommendations are addressed.
• Monitor contractors. The VA uses contractors to inspect state veterans homes and should monitor all of them.
• Be transparent. The VA should share information about the quality of state veterans homes on its website.
The VA has met only one of those recommendations, Sharon Silas, the GAO’s director of health care, said Wednesday. It developed a strategy to monitor its inspectors.
Work on the other two recommendations remains incomplete. The GAO has research planned to further review state veterans homes and get a more detailed look at the VA’s oversight, Silas told AARP.