Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 25, 1995 TAG: 9506260104
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER NOTE: Strip
DATELINE: LENGTH: Long
CALL LIGHTS ARE NOT BEING ANSWERED IN THE TIME REQUIRED BY THE FEDERAL, STATE OR VVCC STANDARDS. THIS IS A WIDESPREAD PROBLEM THROUGHOUT THE FACILITY ON ALL SHIFTS.
The memo, issued by Administrator Mike Little in his first month on the job, directed the nursing staff to test their response time and give "documented" counsel to any worker who didn't answer a patient bell within five minutes.
"This 'Call Bell Test' is to be done until it is completely corrected for three consecutive days," Little's directive concluded.
Unsatisfactory responses to pleas for help from patients has been a continuing complaint at the 21/2-year-old home for veterans, which is owned by the state but operated by Diversified Health Services, a private company.
Six months before Little's memo, a relative of one resident appeared before a meeting of the home's state-appointed Board of Trustees to complain that call bells were not being answered "on a timely basis." She said her relative slept on the commode for "30 or 40 minutes" while waiting for help.
Gaye Huffman, a nurse who worked at the home less than a month this spring as a shift supervisor, said some workers on the 11 p.m.-7 a.m. shift flatly refused to answer call bells. The need for staffing - especially nursing assistants - was so great that employees had gotten used to getting their way with little worry about reprimand, she said.
When he arrived, Little said, he also confronted a staff in which some workers didn't show up for work and didn't call to say they weren't coming. Those workers still expected their jobs to be safe, he said.
His new policy: "No show. No call. No job."
Slow response to the call bells is just one of the topics of discussion at the veterans home, which is next to the federal Veterans Affairs Medical Center at the Roanoke-Salem boundary. The state facility has been hit by allegations ranging from bad food and inappropriate actions by a gun-toting board member to possible wrongful death.
On June 16, the regular meeting of the home's board was confrontational, with residents and their relatives charging that the home is inadequately staffed, especially on weekends, and that complaints go unheeded.
For three days last week, Adult Protective Services investigators and inspectors from the state Department of Health were at the home reviewing records and interviewing residents and staff to determine if the charges of poor quality of care and inadequate staffing were valid.
A report from those agencies should be completed this week, but Little said he was told that the home had no "deficiencies" in the quality of care or staffing. He said current staffing is above state standards.
"But there are concerns," he acknowledged. "For one thing, they thought some of the patients assigned to be bathed at night could be bathed earlier in the evening."
He declined to give further details until the written report is received.
In an inspection last November, the home was cited for dirty and sticky floors, food debris and dirty shower curtains. The report also pointed out that procedures were needed to prevent such incidents as a nurse throwing medications in the trash instead of taking the time to administer them to patients.
When Little arrived, he said, he also found housekeeping to be inadequate. He said he tested the staff's responsiveness by leaving plastic vomit on a floor and watching to see who would try to remove it.
"Every one of them walked right by it," Little said.
Housekeeping workers were demoralized, he said, and he has been working to change that.
Turning up the volume
The Virginia Veterans Care Center has had growing pains that have gone beyond the norm to what board member Dan Karnes describes as "just pain."
Karnes, a clinical social worker at the Veterans Affairs Medical Center in Salem, has been on the board since the beginning.
The volley of complaints about missed or imprecise delivery of medications, of lost clothing, and even of lack of personal grooming care for patients that came from residents' families at the June 16 board meeting was unlike anything he'd heard before, Karnes said.
"We've never had the things said [June 16] said before and with such vehemence," he said.
Records of past meetings, however, indicate that the board had heard similar complaints repeatedly, even though the rhetoric may have been quieter.
The volume was turned up, Karnes said, by the attention the news media had given some of the investigations, especially ones involving trustee Mike Fries of Blue Ridge, who had been the object of some complaints.
Fries was appointed to the board last July.
For several weeks, the League of Older Americans Area Agency on Aging in Roanoke and the Roanoke Department of Social Services have been researching anonymous complaints that Fries verbally abused patients and "brandished a gun" on the property.
Fries has a permit to carry a concealed weapon and admits that he "probably" wore his .32 caliber Smith & Wesson pistol to the home a "couple of times." And he contends the verbal abuse allegations stem from his use of the "f-word" in the hallway.
Generally, Fries says the complaints are "bull and are mainly the results of a messy divorce and his willingness to speak up about problems at the home.
Fries had been barred from the home while the allegations against him were examined. He did attend the June 16 meeting, however, accompanied by his attorney.
Other investigations at the home revolve around claims that unauthorized persons looked at patient records and that some mislabeled medications have come to the home from its contract pharmacy.
The state Board of Pharmacy is investigating a family's complaint that a patient was sent incorrect medicine. The Board of Nursing recently exonerated a nurse of fault in an incident in which a patient was given the wrong intravenous solution, partly because of inadequate labeling. The nurse, who was suspended in January, said she wasn't able to get her job back at the home, however.
The allegations of possible wrongful death are being investigated by Virginia State Police. Robert H. Perry, assistant special agent with the state police office in Salem, referred to the investigation as a "preliminary inquiry."
"We have not identified any victims of wrongful death," Perry said last week. He said his investigation will take time, however, because it requires his office to touch base with all other agencies overseeing the home.
`Too many bosses'
The main value of state police involvement could be that it will create a complete report on the Virginia Veterans Care Center, and that's what state Secretary of Administration Mike Thomas says he wants.
Thomas said he had been "very informed" about the home recently. But he also has become aware of things that occurred last year that he didn't know about at the time.
As Thomas sees it, part of the problem at the home is caused by the board's role as overseer of the facility.
"It is not an advisory board. The board has responsibility for the facility," Thomas said. The structure becomes even "more difficult if you have different board members coming and saying, 'do this, do that.'
"I think a lot of things happened based on personality conflicts.The basic problem is there are too many bosses."
Fries, the outspoken board member, describes the board as inefficient and says all the members ought to resign.
Fries said Thomas has suggested that Fries resign. "They can fire me, but I won't resign," Fries said.
Fries and Thomas are in agreement, however, that the job of executive director, which has been open for several months, needs to be filled as soon as possible. They also agree that the board's role ought to be examined.
"Some people have suggested that we might function better with an advisory board," Thomas said. "That's something we might be looking at."
Fries has suggested that the board be eliminated and the facility overseen by a state agency.
The veterans care center isn't a typical facility. It was built by the Department of Veterans Affairs and given to the state to operate. The board, established by legislation, is an operating board; it collects the lease money from Diversified Health Services and has its own executive director as a watchdog to the operation.
Originally, the home was to be run by state employees; before it could open, however, Gov. George Allen ordered a hiring freeze. The center's Board of Trustees had "no choice" but to find a private company to run the facility, board member Steve Goodwin said.
Board member Steve Goodwin, transportation safety manager for the Department of Motor Vehicles' regional office in Roanoke, and Karnes, a clinical social worker at the Veterans Affairs Medical Center in Salem, have been on the board since the beginning. Fries was appointed last July.
Three more board terms are expiring July 1. Virginia Sen. Malfourd "Bo" Trumbo, R-Fincastle, has agreed to fill one being vacated by Russell Potts of Winchester.
"The home is a great example of what can be done if it's done right," Trumbo said.
Most of what has surfaced at the Virginia Veterans Care Center is no different than at other similar facilities, said Larry Lucas, Diversified's regional vice president.
Staff turnover is no higher than elsewhere, he said.
Lucas was assigned to oversee the facility in February 1994 and he said he had some concerns that it hadn't run as smoothly as it should have before he got there. "And since I got there," he added.
The typical opening pains were also complicated at the Roanoke facility "because the dynamics are different," Lucas said.
The structure is different - a state board and a private operator have had to adjust to each other - and so is the home's population, he said.
"Most nursing home are all female. Here, you've got all males and you've got their wives coming in. Wives have to look after their husbands and no one does it like they do," Lucas said.
"The food is not as good as they cooked. I deal with one lady all the time who says her husband is on a bland diet and can't have waxed beans. When she's not there he eats them and likes them," he said.
Lucas said what he wants right now is for a new executive director to be hired and for Diversified and that director to build a relationship so that together "we can see that residents receive the best care possible."
Staff writer Leslie Taylor contributed to this story.
by CNB