Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, July 23, 1995 TAG: 9507240002
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY AND LESLIE TAYLOR STAFF WRITERS
DATELINE: LENGTH: Long
From the time Bill Hansen arrived at the Virginia Veterans Care Center in Roanoke almost two years ago, he has spent an hour or two each day on the wooden deck tucked in the woods on the edge of the property.
He can still see the center from there, but he can also hear woodpeckers rat-a-tatting.
Hansen, a retired commodities trader and a Princeton University graduate, said he has been grateful for the facility, which is owned by Virginia and open to any former military man or woman who entered service in the state.
He describes his care there as ``exemplary.''
But beyond daily insulin injections that he never learned to administer to himself, Hansen hasn't needed much attention.
The men who share the 25 semi-private rooms in the adult home section of the center need minimal care, mostly housekeeping services for their rooms, he said.
If Hansen, a 64-year-old widower, had not settled at the center, his options would have been an apartment or a private veterans home. Neither appealed to him, he said.
The center has a constantly growing library. The public library bookmobile stops there. Plus, residents can go out to shop or to dinner, and they can use the home's van to go swimming at Smith Mountain Lake.
``We want to see this facility prosper,'' said Hansen, who is president of the care center's residents' council. ``We want to have a home we can be proud of rather than apologizing for living here.''
Occasions for apologies have arisen.
In June, almost three years after it opened, the center got a real kitchen. Residents no longer were served food cooked a day or two before, held in a cooling unit, and then reheated. During the first week of the new food service, however, most of the kitchen staff quit because the work was too difficult.
In July, a controversial board member, Michael Fries, who in the past year had been at the center almost as much as an employee, was permanently barred from the property after investigations by state social services agencies substantiated complaints that he had verbally abused residents and staff members. In addition, on several visits, Fries forgot to leave at home the gun he has a permit to carry.
Also in the past two months, family members of patients in the home's skilled nursing care and Alzheimer's units have complained to board members and administration about understaffing on weekends, failure to give medications on time, not enough attention to grooming of patients and even lost clothing.
And finally, a residents' petition to Gov. George Allen in support of Fries mentioned that he was investigating possible wrongful deaths at the center. The petition touched off a state police inquiry that concluded the allegations were unfounded.
The growing pains for what all parties hope will be a model public-private partnership have been long and arduous, but they may be nearly over.
Diversified Health Services Inc. of Virginia, which has a contract to operate the facility, put a new administrator in place in February.
The board of trustees has advertised the executive director's position, which has been empty since early this year. An acting executive director - John Radick, a licensed nursing home administrator has been appointed to the position in a temporary capacity.
Diversified Health Services is just now breaking even on its investment in starting up the system, and the company would like to continue operating the center if the board renews the contract that comes due in November, Diversified President Jim Goodrich said.
In fact, Diversified is required by the original contract to continue operating the $15.3 million facility if the board wants it to. Besides, Goodrich said, he wants to improve services at the Veterans Care Center.
Michael Little, center administrator, said he is eager to renew the contract. The center's relationship with Diversified, he admits, had not been ``ideal.''
``I'm looking forward to a much smoother relationship now,'' Little said.
Hansen's take on what has happened at the home is that a previously weak administration let complaints mount; when Fries was appointed to the board, he set about solving some of the problems.
Before Fries, Hansen said, residents would get an ``affirmative'' reply about a concern, ``but nothing was done.''
He acknowledges, however, that Fries had ``shortcomings.''
Three investigations into complaints against Fries verified that he verbally abused residents and staff, some of whom characterized him as a controlling, terrorizing ``bully.''
Fries called the complaints ridiculous, but the governor reviewed the investigative findings and booted Fries off the board last month. Fries, who had been appointed by Allen, simply accepted the news. Fries said he understood that getting "me out of their hair" was the "politically expedient" thing to do.
If nothing else, the investigations directed attention to the care center and heightened public interest in a state facility that has operated quietly, almost secretly, for nearly three years.
The Virginia Veterans Care Center was dedicated on Veterans Day 1992. A week after opening, the staff boasted of having fielded hundreds of inquiries. Yet, after five months of operation, the care center had filled only 64 of its 240 beds.
Brett Elmer, who was then the administrator, declared recruitment right on schedule, though, and said he hoped to fill all beds within a year. The center embarked on an aggressive statewide marketing campaign, using radio to advertise. Staff also delivered presentations on the home to veterans' organizations around the state.
One former employee, who worked at the care center during its first year of operation, said the mission was to fill the facility as quickly as possible.
The result? Not enough office or care staff to handle the rapidly rising number of residents, said the former employee, who asked not to be identified. And veterans were processed so quickly that they had no clue what they were getting into, the former employee said.
``There were times when they would bring people in who were not informed about how they were going to be put on a budget - something like $30 a month,'' the former employee said.
``I would get these elderly men who had been independent, who would come in and, when I informed them about the budget, would go nuts.''
The former employee recalled picking up one veteran at a hospital and bringing him and his few possessions to the care center.
``As he was signing the papers when I admitted him and he realized he was only going to get $30 a month in allowance, he got upset,'' the former employee said. ``What was he going to do? He had no place else to go.''
The $30 monthly allowance is limited to those residents who receive benefits from Medicaid, a federal-state health care program for indigent people. Those who receive a state auxiliary grant, a negotiated rate or a VA subsidy are limited to $40 to $60 a month in allowance. Those who don't receive subsidies have no allowance limits.
About half of the care center's 232 residents receive Medicaid and are therefore limited by the $30 allowance, said Kitty Sutphin, the care center's director of social services and admissions.
Set by the Virginia Department of Social Services, the $30 limit hasn't changed in years, she said.
``It's certainly not enough to cover their needs,'' Sutphin said. ``Thirty dollars won't even buy you cigarettes for a month.''
The veterans care center could qualify as the most investigated and inspected state facility in Virginia. At least 14 state and federal agencies have some kind of regulatory control over or interest in the center.
Since February, there have been nine inspections and investigations there. Another state agency survey is expected before November. The neighboring VA Medical Center will conduct an annual inspection before the end of the year.
What these agencies look for varies - from dirty floors to inadequate staffing to breaches of confidentiality.
An example: Every year, the VA Medical Center sends a team of staff members to inspect the facility. The U.S. Department of Veterans Affairs requires the inspections to assure that minimum standards of care, as prescribed by the VA, are met.
The most recent VA inspection was conducted in November. In a summary, medical center Director John Presley wrote that the review team had many positive remarks about the facility.
But several deficiencies were noted.
The inspection team found no evidence of annual medical and mental status evaluations for residents of the center's adult home unit; found food delivered to one unit and left out in the open, allowing residents to take food freely off trays without supervision; found, in one unit, no process for monitoring fluid intake.
The care center staff did submit plans to correct deficiencies, at Presley's request. But when interviewed last month, he declined to characterize any of them as serious.
``I've seen nothing from the inspection report that would lead me to believe veterans are not getting proper care next door,'' Presley said. ``I haven't seen any real red flags.''
His only concern was for the center's management.
``When you think about it, it's a strange administrative arrangement,'' he said. ``I don't have any jurisdiction over it, except to look at it when we send patients over there.
``It's a beautiful facility. All they need now is to get some clearing up and clarification of who's supposed to be in charge.''
by CNB