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VA's rating system for its nursing homes will be reviewed by GAO

By ROSE L. THAYER | STARS AND STRIPES Published: September 25, 2019

AUSTIN, Texas – The Government Accountability Office will examine how the Department of Veterans Affairs rates its nursing homes at the request of three senators, who announced the upcoming review Monday.

Sens. Edward J. Markey, D-Mass., Elizabeth Warren, D-Mass., and Jon Tester, D-Mont., who is the ranking member of the Senate Committee on Veterans’ Affairs, sent a letter to the GAO with the request in August, following a number of “reports indicating poor quality ratings as well as disturbing anecdotal stories of substandard treatment and conditions at some” nursing homes over the years.

The VA refers to these facilities as community living centers because they are not solely intended for end-of-life care but also a place to recover from surgery or a mental health crisis or to receive respite care. The VA operates more than 100 of these facilities across the country.

The senators asked the accountability office for a review in August, before this month’s revelation of an ant infestation at the VA’s Atlanta nursing home.

Officials at the Eagle’s Nest Community Living Center in the Atlanta VA Medical Center confirmed that three veterans were bitten by ants that had infested rooms in the facility. One veteran, a cancer patient, was bitten more than 100 times in the days before he died. The incident led to disciplinary action for nine employees, including the removal of two leaders at the southeast regional level.

The Atlanta nursing home isn’t the only facility encountering bugs. The Northern Arizona VA Health Care System’s community living center in Prescott had a bout with bedbugs this month, according to an internal email from the system’s director.

“Bed bugs can occur in any hospital,” Director Barbara Oemcke wrote Sept. 16. She further advised employees to follow their local policy on encountering bedbugs and to call the in-house pest control to allow the facility’s “professional team of experts to treat and exterminate” the bedbugs.

Three of the bugs were found in two rooms earlier this month, according to Mary Dillinger, spokeswoman for the Prescott VA. Staff immediately “reported the incident to pest control officials, who followed protocol by conducting preventive measures throughout the hospital and resolving the issue,” she said. “No patients were found with bedbugs on their person, and this incident did not negatively affect patient care in any way.”

Nearly 60 percent of exterminators said they have encountered bedbugs in nursing homes, according to a 2018 survey conducted by the National Pest Management Association.  

When the VA first released star-rating data in 2018, nearly half of the nation’s centers were rated one-star, the lowest rank, according to the senators’ release. The latest data has shown improvement in these ratings.

The VA, however, refuted the senators’ information. The agency said its own data shows only 11 community living centers had the one-star rating at that time, based on various factors including nurse staffing and unannounced inspections. The VA data showed the majority of facilities had a rating of four or five stars.  

“We appreciate that many community living centers care for a disproportionately complex resident population with multiple chronic and difficult conditions,” Markey, Tester and Warren said in the statement. “But public concerns and reporting underscore the need to ensure [community living centers] have the tools, resources and properly trained staff necessary to provide the quality nursing home care our veterans need and deserve.”

VA welcomes GAO’s oversight, said Susan Carter, spokeswoman for the department.

“Like any health-care provider — including those in the private sector — VA nursing homes sometimes encounter isolated problems, and when we find them, we fix them,” she said. “But overall, VA’s nursing home system compares closely with private-sector nursing homes, though the department on average cares for sicker and more complex patients than do private facilities. Many of our patients carry the wounds of war.”

The rating system used for VA nursing homes is an adapted version of Medicare’s five-star methodology based on health surveys, staffing and quality of resident care measures. The health surveys and star ratings are available on the VA’s website, as well as a map to compare the ratings with nearby facilities.

When comparing the community living centers with non-VA facilities rated by the Centers for Medicare and Medicaid Services, VA has a lower number of low-performing facilities and a higher number of high-performing facilities, Carter said.

In a letter to Tester’s office, the GAO said a staff member should begin reviewing the rating system in about four months.

Thayer.rose@stripes.com
Twitter: @Rose_Lori
  

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