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.


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.


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:

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:

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.


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

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.





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.


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.





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.


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.





Sadly, the worst possible scenario in Dallas would be the survival of the only Ebola case in this country, Thomas Eric Duncan.

The New York Times helps explain why the Ebola virus has spread so quickly across West Africa.

“In the next ward, a 4-year-old girl lay on the floor in urine, motionless, bleeding from her mouth, her eyes open. A corpse lay in the corner — a young woman, legs akimbo, who had died overnight. A small child stood in a cot watching as the team took the body away, stepping around a little boy lying immobile next to black buckets of vomit. They sprayed the body, and the little girl on the floor, with chlorine as they left.”

“The hospitals in the region simply aren’t equipped to deal with the disease at the rate that it’s spreading. They don’t have the right tools or resources to care for existing patients, let alone stem the spread of the disease.”

With such conditions in West Africa, those that have symptoms are going to be clamoring to get to health care here in the US.

Stopping the flights from affected countries would be ludicrous. There are too many ways to circumvent air travel restrictions.

The biggest fear would be the invasion of contaminated Ebola patients coming across the porous border from Mexico to receive health care in this country.

There would be no way to quell the influx of those infected with Ebola from crossing our southern border.






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.


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.