WASHINGTON — The coronavirus experience at state-run nursing homes for veterans gives a good glimpse into the problems experienced by long term care facilities generally, according to Rep. Julia Brownley (D-Calif.), chairman of the House Veterans’ Affairs Health Subcommittee.
“At the Holyoke Soldiers’ Home in Massachusetts, at least 158 residents of the 278-bed facility — 57% — have tested positive for the disease,” Brownley said Wednesday at a hearing on the oversight of state-run veterans’ homes during the pandemic. “So far 76 residents have died and at least 83 staff members have tested positive for COVID-19.”
She added that “according to an independent investigation published in late June, a series of utterly baffling management and leadership failures, coupled with a severe staffing shortage, delays in testing, delays in closing common spaces, and failure to stop rotation of staff among units contributed to the rapid spread of COVID-19 throughout the facility.”
Unfortunately, “the Holyoke Soldiers Home has been waiting for years for the state to help fund a renovation project that could have helped the facility better separate COVID-positive and COVID-negative patients when the virus arrived,” Brownley said.
No Reporting to CDC or VA
Another example she cited was the New Jersey Veterans Home, in Paramus. As of July 22, “199 residents of the 336-bed facility, or 59%, had tested positive for COVID-19 and 81 had died,” Brownley said. “There have also been 93 cases among staff, including one death. Employees of the facility say admins told them initially not to wear masks, gowns, or gloves because ‘it would scare the residents,’ and said the facility didn’t provide pre-pandemic training on donning and doffing of PPE [personal protective equipment] … and other infection control procedures.”
Since the start of the pandemic, at least 40,000 residents of long term care facilities nationwide have died of COVID-19, Brownley said. “Unfortunately, we do not know how many deaths occurred at state veterans’ homes or the extent to which these residents are reflected in the 40,000. That’s because not all state veterans’ homes [are] required to report data COVID-19 infection and mortality data to the CDC or the VA [Department of Veterans Affairs].”
However, she added, “We understand not all state vet homes experienced COVID-19 outbreaks like those I described. Administrators in most state veterans’ homes have worked tirelessly to keep veterans safe, and for that I’ve been thankful.” She singled out Vito Imbasciani, secretary of veterans affairs in California, for his efforts. Veterans home directors in that state “implemented an emergency operations plan and stocked up on PPE … It seems to have made a real difference. I hope we can identify and spread best practices to other homes.”
Rep. Neal Dunn, MD (R-Fla.), the subcommittee’s ranking member, said that “due to multiple inherent risk factors such as age, health, and difficulty physically distancing, veterans in state homes are particularly vulnerable to COVID-19.” Noting that states are currently responsible for day-to-day management of these facilities, “given the unique circumstances of the COVID-19 pandemic, now is the time to reevaluate that relationship.”
He also took the executive branch to task. “Across the country, staff continue to report they need more access to PPE, and they report that the PPE sent to nursing homes by the federal government might be inadequate to the task,” Neal said. “What’s happening in nursing homes across the country right now is not a coincidence; it’s a longstanding deregulation campaign that has been waged against nursing homes for years … More needs to be done to contain the virus to protect these patients and workers, and keeping the administration on keel for that is essential.”
Paul Barabani, a member of the Holyoke Soldiers’ Home Coalition, noted that the most recent VA survey of the home — completed on January 31, 2020 — found that the Holyoke facility didn’t have an infection control program. He recommended “a much greater collaboration and partnership between the VA and the veterans’ home … Imagine if the VA facility of jurisdiction and the home had worked collaboratively to implement such a policy in the month of February.” Such a partnership could include access to VA online resources, joint participation in disaster preparedness exercises, including infectious diseases outbreaks, assisting with placement of challenging residents, and assistance with quality management, dietary, pharmacy, and infection control, he said.
Sharon Silas, director of healthcare at the Government Accountability Office, highlighted findings in the GAO’s 2019 report on state-run veterans’ homes, including the fact that the VA uses outside contractors to inspect the state homes and that the VA allows its contractor to cite some lower-level failures to meet quality standards as “recommendations,” rather than as deficiencies. “We also learned VA permitted contractors to allow state veterans’ homes to fix issues while the inspector was on site conducting an inspection, to avoid being cited for a deficiency in their inspection report. For the 2018 contract year, state veterans’ homes had a low number of deficiency citations, an average of one deficiency per inspection, as compared to community living centers, which averaged four deficiencies per inspection,” likely as a result of these policies, she said.
Brownley expressed concerns about oversight. “To me, the way oversight is structured right now, it is loose, and should be at a minimum tightened up quite extensively,” she said, noting that the VA doesn’t monitor its contractors’ performance of inspections.
Rep. Mark Takano (D-Calif.), chairman of the full Veterans’ Affairs Committee, expressed concerns about COVID-19 testing at the homes — specifically, the rapid tests that the Centers for Medicare & Medicaid Services (CMS) is planning to send to all nursing homes, which he said included Abbott’s ID Now rapid test. “My understanding is that the false negatives are still a problem,” he said. “It makes no sense to use a test with at least a 25% — I’ve heard a 50% — accuracy problem for infection control … I find it absurd that this is CMS’s solution.”
A press release from CMS said the agency is planning to send the homes two other tests, the Quidel and BD Veritor rapid point-of-care tests that detect viral proteins rather than genetic matter. The release noted that these tests “may be slightly more likely to have a false negative result than molecular PCR COVID tests.” The false negative rate of the Quidel test is 20%, while the rate with the BD Veritor test is 16%, according to news reports.