Category Archives: DEPARTMENT OF VETERANS SERVICES

PROJECTING THE PERCEPTION OF CARE AND CONCERN

 

OPINION:
As a resident of a state-run long-term care facility, I’ve been exposed to a management style  much different from my experience in the private sector.

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The most important characteristic of leadership is to convey the perception of competency and concern. Not only in the delivery of the final product or service but for the well-being of those employees that actually perform the one-on-one service. Visible leadership is essential at the time of adversity when employees are asked to perform above and beyond the ordinary. Employees and residents deserve and expect the same from management. To do otherwise creates a disconnect between management and employees and breeds disrespect, doubt and resentment.

During the blizzard of 2016 in Richmond, no member of leadership was on site to offer direction, leadership or control over the operation during the adverse conditions. Employees were told to risk personal safety and property damage to be at work. No “call outs” would be accepted! Confidence and respect towards management were shattered. If employees are considered “essential personnel” leadership, too, must be essential. Otherwise, why do we need management?

Visibility emits not only confidence and competency but concern for the outcome of the task at hand. It brings unity and strength towards the achievement of the goal: the comfort and care of resident veterans. Invisible leadership projects the image of incompetence and indifference.
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VETERAN DENIED DIGNITY AND RESPECT: Repost of my thoughts, facts, and opinions expressed on December 29th, 2014. bc

PERSONAL

VETERAN DENIED DIGNITY AND RESPECT

DECEMBER 29, 2014 LEAVE A COMMENT EDIT

Sitter and Barfoot Veterans Care Center has exposed its hypocrisy toward the principles that a veteran served to protect. Dignity and respect are the foundations of trust and credibility. The state run Veterans Care Center has failed to embrace these principles.

SITTER AND BARFOOT SIGN (4)

After back surgery and therapy at McGuire Veterans Medical Center, I was admitted to Sitter and Barfoot on Friday afternoon, December 9th, 2011—unable to walk or stand. I was transferred under the pretense that it was for “therapy.”

Ten days later, the Director of Social Services, Dana Rivera, gave me a document informing me, “We have reviewed your case and decided that Medicare coverage of your current services should end.” Sitter and Barfoot had made this decision after five days therapy and observation.

The Director of Social Services told me, “You will spend the rest of your life here.”

This unsigned paper ended my Medicare Coverage. The change made it necessary for me to liquidate all my assets and to convert my medical coverage to Medicaid. The appeals process was the only option offered. All my petitions were denied without explanation.

Half-truths and memory lapses confuse the circumstances around the change from Medicare to Medicaid. How could Sitter and Barfoot come to the conclusion that services should end without the input of a medical professional—in only five days of observation and therapy? Repeated inquiries have resulted in different responses.

I pressed Ms. Rivera to name the person who had given her the document. The director replied, “Diane Handler.” I had never heard the name.

I learned that she was a therapist in the rehab department. Finding her office, I asked her, “Who wrote this?” She said she had, and I asked her to sign it.

I received a contradictory email on January 19, 2012.The Director of Rehabilitation, David Mansolino, stated that he, in concert with his Certified Occupational Therapy Assistant, Charles Evans, had made the decision.

It remains unclear why Diane Handler signed a document she hadn’t authored.

On January 17, 2013, Robyn Jennings, Director of Nursing, told me that she had conversations with Mr. Mansolino. Mr. Mansolino told her that he conferred with therapists, and physicians at McGuire VA Medical Center, yet he cannot remember any names.

After several emails, Ms. Jennings confirmed my suspicion—David Mansolino couldn’t remember with whom he may have spoken.

A judgment he made that had a devastating effect on my life. Stripping from me a lifetime of accomplishment.

David Mansolino has also shown careless record keeping by losing an email I sent him on April 30th, 2012. The email was a request to determine whether I needed approval from his rehab department to make transfers. An OK that would allow me to make slide board transfers from wheelchair to bed and back, without supervision.

He never responded. When confronted with his mistake, in front of the administrator, Sandra Ranicki, he maintained that he couldn’t find the email. Perhaps he’d given it to his Assistant, Charles Evans—once again, a memory lapse.

Since my arrival at Sitter and Barfoot I’ve repeatedly asked for the go-ahead to use an external catheter. The device would allow me to return to community activities with comfort, confidence, and dignity. Sitter and Barfoot had blocked all attempts to provide me with the device despite the recommendations from three medical doctors at McGuire VA Medical Center.

I received excuses when I made requests. “They weren’t intended to be used in a long term nursing facility.” Or, “You run the risk of UTIs [urinary tract infections] and skin breakdown.” Finally, it was just, “against policy.”

The attending physician, Doctor Philip Boulanger, finally gave consent to use a catheter for up to eight hours. However, my community activities would have exceeded the eight-hour restriction.

On February 12th, 2012, I sent an email to the administrator requesting information on the policy. The email was ignored.

In desperation, I contacted the ombudsman to see if I could gather additional support to reenter the community with comfort and dignity.

I requested a meeting with Sandra Ranicki, administrator from Sitter and Barfoot; Robyn Jennings, the Director of Nursing; Debbie Kopacki, the ombudsman from Senior Connections, and myself. The meeting was scheduled for February 24th, 2012.

Ms. Kopacki was aware of my personal needs and expectations; to regain an activity level close to what I’d had experienced before—to return to the community, and to be productive.

As expected, Ms. Ranicki and Ms. Jennings voiced their resistance to the external catheter, mentioning their experiences, concluding that it was against Sitter and Barfoot’s policy.

I expressed my reasons for the device—I had volunteered for the Wheelchair Games to be a greeter at the Civic Center, and I couldn’t attend without one.

I then looked to Ms. Kopacki for support. To my surprise, she related conditions from her previous nursing duties and sided with the administrator and the director of nursing. My supporter was echoing the same denials that I had already heard.

I was furious.

I continued to pursue the policy source. I was told that it was the policy of the Medical Director and the attending physician. They both denied responsibility.

The policy seems to be the making of everyone’s imagination. The Centers for Medicare & Medicaid Services (CMS) conducted an interview on 07/11/2012. A Central Supply Staff member (Other F) is quoted as saying they, “used to have two residents several months ago that used them [external catheters], but there are currently no residents who utilize them.”

I have never received nor has anyone been able to produce a policy. Ms. Jennings justified my skepticism in a meeting 1/17/2013. She couldn’t provide a written copy from the manual saying, “It must be in storage.”

Ms. Ranicki expressed her insensitivity towards resident’s dignity and respect. In 2012, my personal mail was opened twice; two different checks diverted and deposited into the wrong account without my knowledge. Ms. Ranicki’s defensive stance was that Sitter and Barfoot was doing it as a “convenience.”

Opening personal mail has been—and continues to be—the practice at Sitter and Barfoot since my arrival. On the survey done July 17, 2013, “Employee-B stated that she sorts the mail that comes into the facility. Employee-B stated that mail that is addressed to residents goes to the resident except for mail that has anything to do with money then it goes to the business office.”

Ms. Ranicki’s callousness towards me was revealed in her response to the Department of Health surveyor on July 18th, 2013. When the administrator was questioned about the unannounced searching of my personal space, she is quoted as saying: “she did not perceive that what the CNA [Certified Nursing Assistant] did was a violation of Resident #5′ s [sic] privacy.”

These are examples of deception, distortion, and controlling character at Sitter and Barfoot; all at the expense of one veteran that has served his country. My experience, I fear, is “the tip of the iceberg.” I’m just one resident of a possible 160.

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Sitter and Barfoot Veterans Care Center has shown that it is incapable of self-governing.

There is no operational oversight from the Department of Veterans Services. Sitter and Barfoot operates unsupervised and with impunity—held accountable only to the Department of Health once a year and an annual survey done by the Department of Veterans Affairs. Both inspections are superficial exercises to meet administrative requirements.

Ask most any long-term resident if they’re happy, most will say “yes.” Why? Residents are intimidated and are afraid—afraid knowing that Sitter and Barfoot is the last stop.

Most family members don’t know what to look for, don’t have the time to ask, or just don’t care. Family members take for granted their loved one is getting proper care.

The Veterans Care Center, for many, is the last sanctuary for veterans just waiting to die—just waiting to fade away and be forgotten.

Sitter and Barfoot is just another nursing home; no better, no worse.

Absent is the direction, leadership, and moral code to set Sitter and Barfoot apart; it has neither the desire nor the incentive to excel. Just maintain the status quo and cover its tracks on the backs of heroes.

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Sadly, the Director of Social Services may have been right—I may spend the rest of my life here. However, I’m not giving up my dignity, and I’m not giving up my deserved respect.

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AN OPEN LETTER TO VIRGINIA GOVERNOR TERRY McAULIFFE

VETERAN

1601 Broad Rock Boulevard # 103
Richmond, Virginia 23224

March 15, 2015

The Honorable Terry McAuliffe
Governor of Virginia
1111 East Broad Street,
Richmond, VA 23219

Dear Governor McAuliffe:

If trust and transparency are to be the cornerstones of your administration, you need look no further than Sitter and Barfoot Veterans Care Center (SBVCC).

SBVCC has refused to conduct business in an atmosphere of trust, transparency, and professionalism; instead, choosing to operate under a blanket of deception and secrecy.

One has to question the motivation behind such policies and practices—what are they trying to cover-up and hide? Why the refusal to be accountable and transparent?

Residents of a nursing home are not considered credible; they have no voice—it is only through the voice of the responsible party that they can be heard.

I am the responsible party. I conduct my own business and personal affairs: banking, taxes, social security, Medicaid eligibility, college courses, etc. It is absolutely necessary to communicate electronically to reduce confusion, misunderstanding, and to remove vagueness.

Memories can be refreshed with written communication—verbal communications cannot. Verbal communications leave the door open for uncertainty and conflict. Verbal communication allows for doubt, deceit, and deniability. Written emails open lines of communication that permit accountability, clear understanding, and verification.

Sitter and Barfoot is a high profile agency within your administration. Its practices are not only unacceptable, but an embarrassment to your administration’s efforts to regain trust and transparency in state government.

It is mandatory that the communication practices and policies of Sitter and Barfoot be reviewed, and corrective actions are made.
Sincerely,

Robert Carr

CHOOSING A NURSING HOME: THE NEXT TO LAST DECISION YOU’LL MAKE FOR A LOVED ONE

OPINION:

VETERAN

Reality has hit home and the alternatives are complicated. Options are limited and uncertain. Time may be of the essence. Motivation for such a move may be the inability or the unwillingness to provide the necessary care. Both justifications come with guilt.

Placing someone you love in a nursing home, into the custody and care of an unknown—to be cared for 24/7 by persons never seen—demands trust and understanding.

SITTER AND BARFOOT EDITED FRONT

How will you approach the decision? With confidence or confusion? With anxiety or relief? With generosity or selfishness? Haste or with deliberation? As a challenge or an annoyance?

Emotions drain you. You’re surrendering total care and control of a loved one to the unknown, untried, and unproven. You want to—you have to—make the right decision for the loved one and yourself.

Nursing homes know you’re in a vulnerable position. They emphasize the positives and ignore the negatives. They want you to make hasty decisions based on first impressions, and imprecise, flexible language.

It’s quite possibly the last destination before the funeral home for a loved one, and their techniques are very similar. Nursing homes are intent on making a positive first impression. They are selling the unknown to the uninformed.

Many questions go through your mind when making the decision. How will my loved one be treated? What type of care will they receive? What is the quality of the medical staff? What is the availability of trained personnel to meet particular needs? Is emergency care available (defibrillators) on site or do they use outside first responders (911)? How safe will my loved one be?

Your choice of a nursing home is a quality of life and death decision for a loved one.

Appearing too firm can lead to an awkward relationship with the nursing home. A relationship filled with the fear of reprisals, payback, and guilt. Fear of the unknown settles over you.

What happens in nursing homes, far too often, stays in nursing homes.

Nursing homes have the upper hand, and they know it. Complaints are trivialized, ignored, forgotten, or buried under bureaucratic mountains of paperwork and delays. Residents are viewed as bewildered, confused, or having hallucinations….Conditions brought on by dementia or medications.

The Virginia Department of Health, the investigating body, tells you it takes twelve to fifteen months to investigate a complaint, depending on the severity. Some residents in nursing homes would be fortunate to have twelve to fifteen months remaining.

The demand for quality nursing homes far outweighs the supply and continues to grow while quality management and accountability go unchanged or worsens.

Nursing homes do everything to control the resident. It is, after all, their responsibility to provide care, comfort, and safety to those under their protection. They have little flexibility in accommodating individual preferences regarding the personal activities of those under their purview. Personal dignity and respect yield to satisfying the needs of the majority and what is necessary for the nursing home to meet its financial and administrative goals.

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Know their business! Do your research. Ask detailed questions, and know the answers beforehand. Nursing homes have strict federal guidelines that must be followed. The Centers for Medicare/Medicaid Services (CMS) manual is online:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

Know it! Take your time, be thorough, and take notes! Search using keywords identifying areas of concern geared to your individual needs.

Nursing homes don’t follow the guidelines. Nursing homes take shortcuts, speak in generalities, and make vague, yet plausible excuses for deficiencies.

Health inspections: Federal law requires that the most recent annual health department survey be available for public examination. Request the health department surveys for the previous two years. That’s the only way to determine if the nursing home has a history of deficiencies. If they shy away, ask why! Question their refusal.

Don’t go by the sanitized survey results found online. The surveys online don’t specify deficiencies and omit much of the critical details. You’re making decisions for your loved one, and you have the right to make an informed choice.

Resident Assessment: CMS Manual §483.20(k) Comprehensive Care Plan. The Minimum Data Set (MDS) is a comprehensive resident assessment required by federal law under strict guidelines. This evaluation is lengthy (30 to 40 pages in some cases) and must be reviewed with the interdisciplinary team from the nursing home. The nursing home may have its self-interests, may not be informed, or final instructions may be unclear. Do your homework and be prepared. Once again, it’s important to take notes. Don’t yield to pressure from the nursing home and don’t gloss over the importance of this meeting. The responsible party must be given the opportunity to review this assessment in detail prior to the meeting to prepare questions and to correct errors. A simple entry error of “DNR” (do not resuscitate) in place of “FULL” will have consequences.

The MDS reviews all aspects of the resident’s care and treatment including mental acuity or a cognition evaluation. This document may have legal importance if future decisions are challenged by family members regarding end of life wishes, advance care planning or advanced directives. Caution is advised; preparation and participation are mandatory for an interdisciplinary care plan meeting. Allow enough time and remember this is the final care plan for the one you love.

Security of personal items: Nursing homes advise residents to keep a limited amount of cash (no more than $10.00) in their rooms. But they make no guarantees and do very little to stem the threat of theft. I have been robbed four times by employees to a total of $141.00. According to their guiding principle, I should have been robbed a fraction over 14 times.

Photograph valuable items where they are placed in the room: i.e., electronics, memorabilia, and other irreplaceable personal items. Download pictures to a remote computer. Lock up everything else.

Medications: Med mistakes are a persistent problem in nursing homes. Be sure to ask about the med error percentage. The federal guideline is less than 5%. Know the answer before asking the question (15%). Ask why it’s so high and what’s being done to lower this number.

It’s preferred that the resident be able to count! The residents should, from time to time, count the medications dispensed to them. If there is a discrepancy, call the nurse supervisor and report it. Follow up to make sure it’s noted on the resident’s medical chart. The responsible party or the resident have the right and obligation to report med errors to the attending physician and the Office of Licensure and Certification at the Department of Health.

Get a list of all medication to be administered, know what each is for and the side effects.

Personnel: An inspection of employee licenses, background checks, and police records are part of the annual survey done by the health department. Don’t take the word of the nursing home. Nursing homes don’t follow the minimum standards regarding hiring practices. Licenses for healthcare workers in Virginia are online at:

https://secure01.virginiainteractive.org/dhp/cgi-bin/search_publicdb.cgi.

A search can be done with just the first and last name. It shows violations listed with the licensing agency, but only if offenses are reported.

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There are many lists available online to use as a guide for choosing a nursing home. Use them; they are helpful.

https://www.google.com/?gws_rd=ssl#q=choosing+a+nursing+home

However, not to be overlooked is the reality that this is an end of life decision. Checklists are sterile and impersonal. Don’t ignore the personal aspects that shape the end of life experience for a loved one.

The decisions you make have a profound effect on the memories that your loved one takes on the final journey. Do your part. It’s through your involvement, knowledge, and understanding that you will find the peace and comfort you want.

Listen to your loved one—believe in your loved one—and be a strong advocate. Do your research, take your time, and make it a comfortable, peaceful passage for the one you love.

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HARMLESS ERROR

VETERAN

Am I a statistic or a “harmless error” of the Veterans Administration Health Care System?

The diagnosis was that I needed a triple bypass and an evaluation of my heart valve.

My heart surgery was put on the fast track and scheduled for late March, 2011. The result was a “successful” quadruple bypass and a bovine aortic valve replacement.

Beginning in mid-July of 2011, I started experiencing lower back pain on the left side. It became increasing more severe. I finally decided to go to the emergency room at McGuire Veterans Hospital located here in Richmond, Virginia. The ER doctor examined me, and her suspicion was an intestinal issue. I was treated and released.

McGuire VA MEDICAL CENTER

I was diagnosed six weeks later with an abscess between T-8 and T-9 vertebrae caused by the MRSA (Methicillin-resistant Staphylococcus aureus) bacteria that colonized in my spine. The abscess was putting pressure on the spinal nerves and needed to be removed. McGuire Veterans Medical Center performed a laminectomy on my spine, and I have not walked since the surgery.

Below is an excerpt from my progress notes dated 09/21/2011 on page 630:

Plan:
Epidural abscess & Back pain: The source is probably the bovine valve which was replaced on March [30th, 2011] since there is no other obvious cause of abscess in this otherwise healthy gentleman. No history of pneumonias or admissions for sepsis. No hx of IV drug use.

The progress note points the smoking gun back towards the “bovine valve” that was implanted at McGuire Veterans Medical Center five months earlier.

SITTER AND BARFOOT SIGN (4)

The Veterans Administration placed me in a veterans’ nursing home as a paraplegic, cast aside like waste, destined to die a slow and heartbreaking death—alone.

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DEBUNKING THE MYTH

OPINION:

VETERAN

There is no mechanism in place for the Department of Veteran Services to perform operational oversight of Sitter and Barfoot Veterans Care Center, according to the Care Center’s administrator.

Sitter and Barfoot is a long-term care facility that provides rehabilitation services and medical care and comfort to as many as 160 veterans. It has two units, each with sixty private rooms. In addition, there is a specialized Alzheimer’s/dementia wing with forty rooms.

SITTER AND BARFOOT EDITED FRONT

I requested a copy of an inspection done by the Department of Veteran Services. Instead, I was shown the review done by the Department of Veterans Affairs, the federal agency. When questioned, the administrator stated that the Virginia Department of Veteran Services does not inspect the operation of Sitter Barfoot. Further, the administrator said that Sitter and Barfoot is checked twice a year by two separate agencies: one federal and one state.

The two annual inspections, done by the Virginia Department of Health and the Department of Veterans Affairs, are done to evaluate the operation and care given to the most deserving of our aging population.

The Department of Health and Department of Veterans Affairs inspections cover the operation of the Care Center and typically last three to four days. Each department operates independently and comes at different times of the year.

The Department of Health evaluates the overall care delivered to those 160 veterans: quality of care, medical records, privacy, personnel practices; rehabilitation, food preparation, staffing, resident complaints, medications and more. Towards the end of the inspection process, a meeting is scheduled. The administrator and the director of nursing convene with the survey team to review the deficiencies found and draw up a corrective action plan.

Sitter and Barfoot received the highest grade possible in the 2014 survey.

After an interview with a health department surveyor, the health department failed to address four of my concerns:

• Medication errors
• Short staffing
• Ignoring communications
• Lack of dignity and respect

The health department showed little interest in my issues. Complaints from nursing home residents are considered unreliable and often ignored.

It begs to question the effectiveness of such an assessment and the trustworthiness of the Department of Health.

The Department of Health acknowledges a 12 to 15 month wait time to investigate complaints. I now have to wait again to get resolution. Residents in a nursing home would be fortunate to have that many months left.

The cleanliness of Sitter and Barfoot affects those doing the survey and accounts for the disparity between fiction and reality. Cleanliness covers many evils. Overall appearance diverts attention and unduly influences the outcome of the inspection.

The Health Department and Sitter and Barfoot are both state agencies. I question the reliability of one state agency evaluating the performance of another. Corruption, complacency, and a lack of transparency obscure objectivity in government self-appraisals. It is unlikely that a state agency tarnishes another agency’s operation; particularly one with such high and honorable intentions as caring for aging veterans.

The Department of Veterans Services needs more accountability in the delivery of care to deserving veterans.

Accountability does not stop with the administrator. The administrator has self-interests and financial demands to protect, as well as job security for the employees that have shown allegiance. The administrator and staff can hardly be expected to be objective. Government agencies have demonstrated that they do whatever is necessary to protect their province.

The Department of Veterans Services needs to be held accountable and responsive to the needs of all veterans it serves. It is mandatory that the Department of Veterans Services be pro-active and aggressive in ferreting out problems. Not just a self-serving propaganda arm for the Commonwealth.

Accountability at the top will cure the ills of Sitter and Barfoot and the Department of Veterans Services—and accountability with consequences must filter down to all levels.

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PRIVATE ROOMS

OPINION:

VETERAN

Nursing homes mislead the end user by promoting “private rooms.” Misleading because, in fact, that only means the room has a door on it. There is no privacy unless those that have access respect the sanctity of privacy.

I have been a resident of Sitter and Barfoot Veterans Care Center for three years and most of that time “privacy” has been a condition that has had to be regularly requested and often denied. Only after three years do I have a modicum of real privacy.

SITTER AND BARFOOT SIGN (4)

Constant guidance and reinforcement have resulted in acceptance of my desire for privacy. If someone wishes access to my “home,” they knock and ask for permission before entering; it is an essential of courtesy, dignity, and respect. Still, I still have a few that just knock and open the door; much to my displeasure.

Not asking for permission has resulted in friction between me and factions of employees. Some staff members think that I am here for their convenience. The reality is that they are here for my benefit, and they are to adhere to my expectations of privacy.

I have had doctors, staff, and registered nurses just enter my room whether the door be opened or closed. They have been met with displeasure.

Employees of nursing homes should be treated no differently than the contractor you hired to cut your grass, clean your pool, fix your plumbing or the cable guy. You would not expect someone you hired to come to your home and interrupt your dinner nor would you expect them just to walk into your house without knocking. The nursing home staff works for the resident and is hired to perform a service. It is no different. It is a matter of respect.

Unlike life outside a nursing home, once inside you have to demand respect. Nursing homes have the mistaken view that the resident is there for their benefit, not the other way around. Nursing homes control meals, medication, and comfort. Privacy is the last remnant removed from the control of the resident.

Nursing homes will attempt total control of the resident in any fashion they can. However, privacy is not their domain. Privacy is one area that the resident has control, and it should be made clear to the nursing home from the beginning.

Private rooms are not private if everyone one has unfettered and uncontested access.

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ANOTHER DOOR CLOSES

OPINION:

VETERAN

Another door closes.

I requested a physical therapy consult through my outpatient nurse at McGuire VA Hospital.

McGuire VA MEDICAL CENTER

What I was looking for was a comprehensive physical therapy regimen to improve my lower body strength so that I may regain more independence.

The consult was set up with Laurel Hackett in the physical rehab department at McGuire.

Immediately I was aware of her reluctance in accepting my objectives as realistic. I received no encouragement or support. She just gave me reasons why my best opportunity for success was immediately after a spinal cord injury; not 24 months later. No one explained that to me at the time of the injury or in the recovery process.

The second visit I actually got into the standing machine. Laurel took measurements and monitored my blood pressure while increasing the vertical positioning. The session was punctuated with interruptions, moving of equipment, and concern for a patient who had taken his power wheelchair on a tour of the hospital.

Laurel had requested that I provide her with a list of the exercise equipment available to me at the nursing home, Sitter and Barfoot Veterans Care Center. On the third trip, I gave her the list.

SITTER AND BARFOOT SIGN (2)

Laurel began making inquiries as to why I hadn’t approached the therapy department at the nursing home for my physical therapy needs. I explained that there was a communication issue, lack of credibility and void of any enthusiasm or encouragement. She then began to distance herself more. It was clear that she was developing a conversational exit strategy.

Laurel mentioned the fact that perhaps we were “re-inventing the wheel” and that I would be better served talking to a therapist at the nursing home. She persisted to the point that I picked up my list of equipment, and I began to close our conversation.

She made several attempts to regain control of the conversation as I was leaving, but it seemed we were going nowhere.

I left McGuire VA Hospital more disappointed and discouraged as ever and returned to the nursing home.

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THE EXIT DOOR

OPINION:

VETERAN

The reality is, for most people, nursing homes are repositories for those wasting away, waiting to die. No matter how hard nursing homes try to defer the attention away from reality, reality always returns in the lonely hours of solitude.

SITTER AND BARFOOT SIGN (2)

Having been placed in a nursing home prematurely is a frightening, frustrating, and depressing condition thrust upon me unwittingly.

My orientation contained carefully crafted dialog which omitted the term “nursing home.” In fact, those words were never mentioned when discussing my treatment, therapy, or future. It was always referred to as “the Veterans Care Center.” I had no idea I was being cast aside like waste.

My last memory in late July, 2011 was traveling down Hull Street in Richmond, Virginia on the way to the emergency room at Hunter Holmes McGuire Veterans Medical Center.

I remember waking up several days later in bed at Sitter and Barfoot Veterans Care Center after being admitted on August 3. I had never heard of the facility. I didn’t know it was a nursing home where people were left to die. I lingered and languished at the Veterans Care Center in a daze, in and out, with only vague memories of what transpired.

Seven weeks later I was told I had an abscess between T-8 and T-9 vertebrae which was putting pressure on my spinal column caused by the MRSA (Methicillin-resistant Staphylococcus aureus) bacteria. I was transferred back to McGuire Hospital where the VA Medical Center performed a laminectomy on September 21.

I am now a paraplegic confined to a power wheelchair for the rest of my life. I have not walked since the surgery.

After the surgery, I was an in-patient at McGuire Spinal Cord Injury Unit being fed medications through a peripherally inserted central catheter (PICC) until early December.

During this time, my memories are vague, but I do remember some of the nightmares vividly. Most were about the hospital room moving, losing my balance, and the fear of falling.

I was coerced and led through administrative doors that permanently closed behind me. There were no alternatives offered, no turning back. I was ushered through a bureaucratic maze filled with omissions, half-truths, and misleading information. I was never told I was being transferred to a “nursing home.” It was always referred to as the Veterans Care Center or it was for continued “rehab.” No one alluded to the fact the move was permanent.

I was told I needed to provide the VA my “financial records” for Medicare to facilitate the transfer. I was never told details about Medicaid or the ramifications.

Those revelations would not come until December 19th.

I was transferred back to Sitter and Barfoot on December 9, 2011.

All during this time I had only the clothes on my back and $41.00 when I got into the ambulance back in July. During my stay at McGuire, I received some books, and my neighbor brought my laptop from home. That was it!

I was to learn later that was all I would be left with; $2,000.00 after the required “spend down” after a lifetime of work. Several books, a laptop, the clothes on my back, a pair of Sperry Top-Siders plus $2,000.00.

In just over a week, I would find out I would be either homeless or hopelessly and forever in debt.

Below is an excerpt of my progress notes from the VA dated 09/21/2011 on page 630:

Plan:
Epidural abscess & Back pain: The source is probably the bovine valve which was replaced on March [30th, 2011] since there is no other obvious cause of abscess in this otherwise healthy gentleman. No history of pneumonias or admissions for sepsis. No hx of IV drug use.

The bovine heart valve surgery was performed at McGuire Veterans Medical Center.

This is what the Veterans Administration can do to you!

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THE COMMONWEALTH’S CULTURE OF COMPLACENCY

 

OPINION:

VETERAN

The Virginia State Government may make the Department of Veterans Affairs scandal pale in comparison.  Virginia state employees have become more concerned for their own self-interests and have become more unresponsive to the needs of the constituency.

Government agencies in the state of Virginia have a culture of complacency that borders on abuse and perhaps criminality.  Complacent culture follows leadership and filters down throughout agencies led by political appointees and cronies.  They apparently think that they are immune from critical condemnation and serious objective oversight.  Unanswered correspondence or irrelevant and seemingly fabricated responses are the standard.

The Virginia Department of Health can take 12 to 15 months to initiate and investigate a complaint of a resident in the state-operated nursing home, Sitter and Barfoot Veterans Care Center….if they investigate the complaint at all.  If Sitter and Barfoot investigates a complaint, it does not report the results of an investigation to the complainant — even if specifically requested.  It is essentially stonewalled.

SITTER AND BARFOOT EDITED FRONT

The Department of Veterans Services does not have any mechanism in place to provide independent, critical operational oversight of Sitter and Barfoot Veterans Care Center.

With the exception of an annual health department survey that only last three to four days and a superficial annual audit by the Department of Veterans Affairs, Sitter and Barfoot operates with little or no supervision and with impunity.  Complaints about Sitter and Barfoot written to the Department of Veterans Services are re-directed back to Sitter and Barfoot for handling.

Sitter and Barfoot is mandated to make available the most recent surveys for public scrutiny, but to get prior surveys to find a pattern of violations are difficult to obtain.  Once obtained one finds serious, repeated deficits in the area of Human Resources and hiring practices that could potentially put all veteran residents at risk.

Repeated abuses in the area of dignity and respect towards the veteran residents become evident in the review of several surveys.  Continued abuses in the handling of mail have been brought directly to the attention of the administrator.  She has never provided the required follow-up to insure that personal mail is handled efficiently, in accordance with not only federal regulations but Sitter and Barfoot’s own written policies.

 

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