Staffing concerns predated coronavirus outbreak at Holyoke Soldiers' Home
By JEANETTE DEFORGE | The Republican | Published: May 20, 2020
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HOLYOKE, Mass. (Tribune News Service) — Faced with too few nurses at the beginning of a coronavirus outbreak, managers at the Soldiers’ Home in Holyoke merged units and even moved nine patient beds to the dining room, according to a study examining how the staff shortage contributed to scores of infections and 74 deaths at the state-run nursing facility.
The Pioneer Institute, a public policy research group, released the study this week. Meanwhile, relatives of some Soldiers’ Home residents have been raising concerns about staffing and conditions in the facility since the early days of the pandemic and earlier.
About 60% of deaths from COVID-19 in Massachusetts have occurred in long-term care facilities. While the elderly and those with preexisting health problems are the most vulnerable, the disproportionate number of people who have died in nursing homes demands an explanation, said Andrew Mikula, an economic opportunities fellow for the Pioneer Institute.
The Soldiers’ Home reportedly has fared the worst of any long-term health care facility nationwide, with 151 patients infected out of the about 210 living there when the outbreak began.
Mikula said he and study co-author Greg Sullivan were also drawn to study the Soldiers’ Home because of a 2017 series in The Republican that showed there were 600 residents injured by falls, some suffering broken bones and other serious injuries, during a two-year period. In the series, employees, their union representatives and families pointed to problems with understaffing.
“Why didn’t the state or federal government or VA handle it earlier?” Mikula asked.
His research showed multiple audits by the U.S. Department of Veterans Affairs and one conducted by the state auditor’s office did not identify problems with staffing. The only finding about staffing inadequacy in the auditor’s report showed “unnecessary payroll costs for overtime hours,” the Pioneer Institute study said.
“In 2019 a Suffolk University report on the Holyoke Soldiers’ Home asserted that excessive overtime is ‘one of the primary indicators of possible problems with staffing,’ but the 2017 audit report didn’t make that connection, and thus the warnings of union representatives went unheeded,” the study said.
But examinations of staffing levels, for the most part, showed the Soldiers’ Home met state and federal rules, even if the study determined they were inadequate for the amount and type of care residents needed.
Federal staffing standards say each patient should get 2.5 hours of nursing care per day. But the U.S. Centers for Medicaid and Medicare Services recommended in 2001 the standard should be increased to 4.1 hours of nursing time per resident per day — especially at a place like the Soldiers’ Home, where many residents need assistance with eating and using the bathroom or suffer from dementia, Mikula said.
“State officials and leaders at the Soldiers’ Home seem to have applied the staffing standards correctly,” Mikula said in the study. “The problem is that the standards themselves are not sufficient to protect the frail and elderly during normal times, let alone in the midst of a pandemic.”
“While it’s easy to retroactively point fingers, the staffing and managerial concerns at Holyoke Soldiers’ Home that predate the coronavirus outbreak really stand out,” said Sullivan, research director for the Pioneer Institute.
The question of whether mismanagement allowed the outbreak will be answered by various government investigations now underway. Mikula said there are allegations that there was little or no quarantining of residents who were believed to have contracted COVID-19, meaning they were mixed with the general population in tight quarters.
“What we do know is the Holyoke Soldiers’ Home combined floors of the facility because of staffing issues in March, and I believe it accelerated the spread,” Mikula said. “My research does not preclude that it is the main culprit to the horrifying numbers we are seeing.”
Lisa Colombo, a registered nurse the executive vice chancellor for Commonwealth Medicine at the University of Massachusetts Medical School in Worcester, heads a clinical team at the Soldiers’ Home brought in by the state March 30. She told the facility’s board of trustees last month that, when she arrived, she found 10 units had been combined into seven, creating overcrowding that exacerbated the spread of the disease.
“There had been a significant number of people out of work. They were down to 40 people in a staff that was already small,” Colombo said.
Family members said they also saw signs of staffing shortages, which led to serious concerns when the pandemic hit the region.
Laurie Beaudette said she worried about her father, James Mandeville, who had was 83 and lived at the Soldiers’ Home for 16 years until his death from COVID-19 on April 14.
Early in the outbreak, she wrote an email to the director of nurses with a list of concerns, such as bags of unwashed laundry in the hallway and nurses using her father’s private bathroom sink, although there was one nearby at the nurses station. She asked that her father’s bathroom be sanitized daily but never got a response.
“I’m extremely angry that administrators made the decisions they made and allowed that disease to spread through that place like wildfire,” said Beaudette. “I’m pissed off they stole a month or more that I would have been at my dad’s side enjoying his company.”
Beaudette was extremely close to her father, a Navy veteran and retired Hampden County court employee who preferred to be called Jim. Nearly every evening she would visit the Soldiers’ Home and they would play cards.
About a year ago, she said, she noticed administrators began rotating nurses and certified nursing assistants through different units, instead of the previous practice of having the same people assigned to the same floors so they grew to know the residents and their needs.
Beaudette said she witnessed the overcrowding on her father’s floor. “Any room that had double beds, they shoved a third bed in there. (The rooms) are not that big and the beds were not six feet apart.”
The consolidation of units also worried Cheryl Malandrinos, whose father-in-law, Harry Malandrinos, died April 20. He served in the Navy during the Korea War. Later he worked as a teacher for more than 40 years and retired as the head of the business department at Chicopee Comprehensive High School.
On March 13, Malandrinos was told her father-in-law was being moved from the third floor to the fourth because officials were trying to improve care.
“I was against the consolidating of patients,” she said. “I said, ‘You do realize this is counter to social distancing.’ But what else were we going to do?”
Initially, her father-in-law tested negative for the virus and the family was relieved. While they couldn’t visit, his wife Katherine and other family members talked to him on the phone. In mid-April they talked through FaceTime, and Malandrinos noticed something wrong.
It took two days of leaving messages to finally reach someone. Her father-in-law was brought to Holyoke Medical Center on April 19 unable to breathe or swallow.
“He was suffering horribly,” she said. “His tongue was enlarged and he couldn’t communicate, he was struggling to breathe but his mind was fully there.”
He died the next day at the age of 89.
“I’m furious. My father-in-law, did he have a week, a month, a year? Whatever time he had was taken from him,” Malandrinos said. “My hope is that all these veterans did not die in vain and they will learn something and develop better protocols.”
The most recent staffing numbers Mikula could find date to 2014. They show staffing levels broken down into five units, most of which include two or three wards. One of those units exceeded the Centers for Medicaid and Medicare recommendation, with 6 hours of nursing care per resident per day. Mikula said he is still researching why that particular ward, 2 South, had more staff.
The average nursing time on the other units ranged from 2.72 hours for 2 East & West to 3.59 for 1 & 2 North, the study said.
Mikula said it is clear staffing standards need to be modified and there should be better communication between families, employees, Soldiers’ Home managers and the state. As the baby boom generation continues to age and more people need long-term health care, staffing standards must be looked at more comprehensively, he said.
The problem also has to be explored from an economic perspective, he said, since long-term care facilities are often struggling financially and some have gone out of business.
“This is all unprecedented, but for decades experts have been telling us these standards need to be higher,” he said.
The clinical team at the Soldiers’ Home is conducting its own study to determine the proper number of full-time-equivalent staff needed to care for the residents, Val Liptak, the facility’s interim director, told trustees last week.
Currently there are 102 residents at the home, with another 31 living in a unit set up in early April at Holyoke Medical Center to reduce crowding and ensure social distancing. Since an entire floor at the Soldiers’ Home is now empty, up to $2 million in renovations are in progress to remove and replace 70-year-old wallpaper, curtains and old, stained wardrobes in resident rooms, none of which meet with infection control standards. Once work on one floor is finished, existing residents will be moved to permanent rooms on that floor and work will start on a second floor so the residents at Holyoke Medical Center can return to the Soldiers’ Home, she said.
The number of residents permitted will be reduced, likely to 160 or 170, she said.
“We are configuring the number of beds. Some beds are only 24 inches apart,” Liptak said. “You cannot take care of veterans safely with beds 24 inches apart. There were too many veterans in one room.”