Category Archives: PERSONAL


According to figures supplied to me by my nursing home, their turnover rate in 2015 was a staggering 41%.

When I asked the Director of Nursing what her goal was for reducing turnover in 2017, she looked at me like a deer in the head lights.

She gave the impression she had no idea what I was talking about.

I wasn’t surprised.

It begs to ask what they talk about in staff and Quality Assurance meetings.

Because of direct care workforce turnover and callouts, managers are forced to pull nursing staff from one unit to another creating a mediocre resident experience to all those affected. Rather than isolating those unit managers with the highest turnover and using the existing management’s expertise to mentor those that need help and direction, they continue to move staff around diminishing the quality of care to each affected resident.

The obvious fallacy is that there is no one with experience, expertise or desire to deal with turnover.

My nursing home has had nine years to fix the problem.

Staff turnover is not unique to my nursing home but exists industry wide.

My nursing home is quick to tell you, and proudly so, that their turnover rate (41% in 2015) is below the national average (44.4% in 2013).

The condition has been so pervasive that even the aging state and federal inspectors can only identify the problem through numbers supplied by the nursing home.

Surveyors are ill-equipped to offer solutions. It is also not their job. They are, in fact, nursing home “monitors.” They just tell you that you have an employee turnover problem.

Does anyone believe that those numbers are an accurate reflection of reality?  Of a commitment to quality care? Especially when it’s a state agency inspecting another state agency?

I don’t think so.

I believe that there is an unwritten code that says that one state agency doesn’t disparage another state agency. Particularly one with the word “Veterans” in the title.

There is no correlation between the numbers on paper and the quality of the care provided. It’s disingenuous to think otherwise.

Recently I engaged an RN in a robust discussion about employee turnover and the switching of nursing assistants to other units to fill short staffing and call outs.

She adamantly stated that the quality of care had not diminished on her unit as a result of management pulling CNAs from her domain.

“Each substitute was certified and qualified. They were all certified.”

She had lost sight of the personal assets a permanent CNA or LPN brings to the profession.

A CNA brings the unseen skill set of knowing each residents’ preferences. Not just one, but all twenty residents in the dining room.

The unit manager’s priorities are no longer focused on resident’s comfort and dignity, but instead, satisfying the administrative timeline for paperwork, reports, and meetings.

The following day at the breakfast table I witnessed an LPN that no one had seen before, uncover an open, bleeding wound next to me. She began treating the wound in front of all of us. It wasn’t until I commented that the whole scenario was unprofessional that she moved the patient from the table to the hall rather than his room.

Throughout the lunch and dinner meals, I saw LPNs pass medication to residents at the tables while they were eating.

Saturday of the same week no one got me up at seven for breakfast. Breakfast is at eight, and I was awakened at eight-thirty. They were shorthanded, and I was assigned a new CNA from an agency.

The same Saturday and unfamiliar LPN on the evening shift offered me only nine of the twelve pills I’m supposed to get.

Just an example of the inexperience, absence of training, and a lack of understanding of what quality service and care are in the nursing profession. It has been replaced by administrative requirements and away from the resident’s dignified experience.

Statistics and numbers collected from paper reports in no way reflect the hidden assets and skill set that a direct care professional brings to the long-term employer.

There is no substitute for the knowledge, familiarity, understanding, and positive encouragement that the regular CNA brings into the life of the resident.

The exchange of feelings is mutual.

Regular CNAs become family. They are the friendly face residents look forward to seeing each morning. Part of my inner circle. My confidant.

CNAs look forward to coming to work and seeing their residents—their progress and they worry if there is a decline.

The direct care workforce generously share their family with those of us whose families have abandoned us. Residents know the CNA’s and LPN’s family through shared pictures from smart phones and look forward to updates: their newborn, their pets, their ups, and downs.

In return, CNAs receive from the residents support when needed, encouragement, and praise when deserved.

The direct care professionals are the lifeline residents depend on—to the end.

They are the first to ask about the test result.

They are the ones that cheer for our recovery, praise our successes; they are the welcoming, reassuring smile when we return from the hospital.

The direct care professional brings incredible strength. They commit so much of themselves knowing all too well it will only be temporary and will end in loss and a feeling of emptiness.

They are the first person we call when our burdens become too heavy.

They provide us with the last hug we’ll ever get. The last hand we’ll ever hold. The last hint of affection we’ll ever feel.

They are the ones that weep secretly—silently—so that they don’t appear weak when we die.

To break that bond is hurtful, counterproductive, and produces negative outcomes at all levels.

It’s devastating!

Another reminder that the aged are but a useless commodity without feelings.

The administration’s view is that the residents will get over it.

Some may not have enough time left, but the feelings of the residents are of little concern.

Longevity in a nursing home is the greatest uncertainty looming over all of us.

CNAs are just another familiar face that soon becomes but a faded memory when removed from our lives.

Our last bit of warmth, and the acceptance that our contribution in life is appreciated.

C’est la vie.

Nine years the turnover has persisted at my nursing home. Pleas from the residents and the employees have fallen on deaf ears, and concerns have gone unresolved.

The administration continues to cling to the last vestiges of a failing, uncaring, philosophy.



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When staff shortages in long-term care reach a level where it affects my quality of life I can no longer remain silent.

Much of the industry has yet to embrace the concept of PERSON-CENTERED CARE PLANNING (PCCP). It is interesting that the Federal Government has accepted the principle along with the obvious benefits to resident care that accompany it.

Central to this concept is the belief that the resident or responsible party is fundamental to voicing his/her preferences as to the care received. The government has made it an integral part of the annual inspection and nursing home certification process. The MDS (Minimum Data Set) 3.0 mandates certain policies, procedures, and questions to be asked of the resident if the long-term care facility is to participate in Medicare/Medicaid. Specific questions about the resident’s preferences as to his/her environment and quality of life.

Section F of the MDS 3.0 assessment includes, “Preferences for Customary Routine and Activities.” Questions like:

  • How important is it to you to listen to music you like?
  • How important is it to you to be around animals such as pets?
  • How important is it to you to keep up with the news?
  • How important is it to you to do your favorite activities?

I cannot emphasize enough that the resident or the responsible party read each line of the MDS assessment form and understand its significance in obtaining the necessary and desirable care.

An important aspect of the PCCP is the recognition of the resident’s need for stability in their daily routines. Staff shortage causes a disruption in the individual’s expectations and places the resident outside his comfort zone. Inconsistencies and repeated assignment changes have an adverse effect—often upsetting the resident for days at a time.

‘‘Minimum Nurse Staffing Ratios for Nursing  Homes.’’

CMS’s own study reported that facilities with staffing levels below 4.1 hours per resident day  (HRPD) for long stay residents may provide care that results in harm and jeopardy to residents (Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report, 2001, Abt Associates).                           16/pdf/2015-17207.pdf  pg 42200

A report by the National Association of State Units on Aging, published in 2005, entitled, ‘‘Nursing Home Abuse Risk Prevention Profile and Checklist’’ concluded that understaffing and inadequate training of NAs [nursing assistants] are major causes of abuse, especially for individuals with dementia.  pg 42224

Residents in a long-term care suffer through enough indignities each day. The changing of staff only worsens the condition. To have a constant parade of strangers come thru my room to attend to my daily needs, to help me dress, to help me shower, is unsettling, to say the least. I have my routine, a certain sequence of events, a certain way I prefer things to be done. I have to repeat my desires with each and every stranger from each and every department.

The regular staff knows:

  • What time I like to be awakened
  • What my morning medical requirements are
  • How I like my bed made
  • That I don’t like the overhead light left on
  • I like my door left open in the morning after I’m dressed
  • I like the bathroom door closed
  • That I drink a small milk and small prune juice for breakfast
  • That I want my personal coffee cup filled with only hot water in the morning
  • For lunch and dinner, I drink regular coffee
  • I provide my ice and cold drinks for my room and dislike being interrupted
  • Laundry personnel put my clothes away in the proper drawers
  • They know what time I prefer to go to bed

All the above contribute to my comfort and a feeling of contentment and control. My expectations are met.

Staff members working extra shifts to fill in for shortages can only result in a decline in the level of care residents receive. Three and four days of sixteen hours each increases the risk of injury to the resident, the staff, an increase in med errors, and a premature onset of employee burnout. It results in an unhealthy work environment. Nerves get frayed, tempers are short, and instances of resident abuse rise as does friction between employees causing more turnover.

A report by the National Association of State Units on Aging, published in 2005, entitled, ‘Nursing  Home Abuse Risk Prevention Profile and Checklist’’ concluded that understaffing and inadequate training of NAs are major causes of abuse, especially for individuals with dementia.

The research showed that nursing assistants in 10 Philadelphia-area nursing homes selfreported  [sic] abusive behaviors over a one month period. During this period,

51 percent reported yelling at a resident in anger;

23 percent insulted or swore at a resident;

8 percent threatened to hit or throw something at a resident;

17 percent excessively restrained a resident;

2 percent had slapped a resident; and

1 percent had kicked or hit a resident with a fist.    pg 42224

Administrations cover up understaffing by transferring staff from one unit to another. One such employee had her assignment changed three times in forty minutes. This just spreads the resident  and employee disruption and dissatisfaction throughout the entire population.

The following is a benefit analysis for proper staffing:

How Does Consistent Assignment Benefit Residents?

Residents do not have to explain to new caregivers how to care for them day after day.

Staff can respond to resident needs more quickly, confidently and naturally when they know the residents.

Residents are more comfortable with the intimate aspects of care when they know their caregivers.

Residents with dementia are much more comfortable with familiar caregivers.

Residents can have stronger relationships with staff.

Staff are more likely to detect residents’ clinical problems early when there is consistent assignment.

Residents have more choice and control.

Residents participate more in activities.

How Does Consistent Assignment Benefit Nursing Home Staff?

Staff members know individual resident’s preferences, needs and routines.

Staff give better care and can be more organized when residents and team members are known.

Having meaningful relationships with residents increases staff job satisfaction.

Staff absenteeism decreases.

Staff have more positive attitudes.

How Does Consistent Assignment Benefit Nursing Homes?

Nursing homes have better staff and resident satisfaction.

Nursing homes have better quality measures and fewer survey deficiencies.

Nursing homes have fewer family complaints.

Nursing homes have decreased staff injuries.

Nursing homes have lower staff turnover and absenteeism, which help reduce costs.

It’s difficult to understand why, with the positive gains to be made by proper staffing, that understaffing continues to be a chronic problem in long-term care. Prolonged staff shortages and high turnover are a direct result of the administration’s mismanagement and their lack of concern for the care and well-being of their residents and their employees.



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SENTIMENT LOST: Sympathy, Care and Kindness


Unknowing and uncaring family members ignore those closest to the aging at the end.

I have spent over a year sharing a table, eating three meals a day, celebrating holidays, birthdays; discussing politics, opinions, innermost feelings, ups, and downs with people who, until recently, were total strangers.  Over time, a bond is formed.  It’s the last friendship.

When a resident first arrives at a nursing home,  fear and loneliness set in. Residents reach out to those they become familiar with; those they eat with and those they connect with in activities. It is a bond cemented by the commonality of a depressing, unspoken reality.  We are all waiting to die.  That’s the reality. We are reminded of it each time someone passes.  Another empty room, another empty space at a meal table.

When a resident dies the family is drawn in to handle final affairs, nursing home relationships are overlooked. I have shared the good, the bad, the pain and suffering of my declining years with those that I have become familiar. They too have shared their history of family dysfunction and disease with mutual confidentiality. Intimate details and feelings not even shared with family.  Perhaps the family is fearful that I know too much.

I have never been given the opportunity to pay my respects; unable to express sympathy, sorrow, or sense of loss with a family I had grown to know only briefly. The deceased is whisked away.  Removed from meaningful relationships by a family that treated my friend as if he had become a burden in later life—disposing of what remains as if the dead had no friends in the nursing home. No kinships. Nothing!

I’ve experienced it twice.  Once with Clarence, who shared with me his family history in Virginia and West Virginia.  Again with Tom.  His life story spanned both Virgina and Florida.  I was fortunate to see them both just days before they died.  I don’t know if they were aware of my presence.  It was the last goodbye.

I was ignored by both families.

Fleeting, fragile, short-term friendship. Another empty chair at the table.

Such is life—and death—in a nursing home.

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BREAKDOWN OF FAMILY: The Overlooked Consequence


Nowhere in the framework of society is the breakdown of the family more evident than with the aging. With the need for two incomes to support the family, no one is home to care for the elderly. The solution to one of the most perplexing issues facing a family has been found.


“In the U.S., nursing home chains have flourished since the 1970s, subsequent to the passage of Medicare and Medicaid and the extension of public payment for nursing home residency.“ — Light, D.W. (1986). Corporate medicine for profit. Scientific American 255: 38-45.

This act has completed the acceptable end of life drama for many households. The painful and depressing disposal of the elderly in a satisfactory and a seemingly compassionate manner has now become a reality. Family members can wash their hands of the sick and dying, delivering them to the care and comfort provided by others, paid for, to a large extent, by the government. The next of kin can now pursue their selfish endeavors cheerfully and guilt-free.

The degree of disintegration in families was readily apparent when I attended a Family Council Meeting in a nursing home; a meeting of relatives and responsible parties to discuss the care and comfort of a loved one put away in a long-term care facility.  These meetings are held at regular intervals throughout the year.  It gives family members an opportunity to meet with the administrative staff, presumably to air out differences, address grievances, and ask questions. This is the occasion to talk to the policy makers of the nursing home. My most recent experience was a sad example of family apathy, lack of family concern and lack of family participation. Two concerned people showed up for the meeting in a 200-bed facility. I was one of them.

Family breakdown has been the bane of the society for decades.  It’s not something that slowly crept up on us from nowhere. It’s only now becoming a concern for those of us that have ignored or tried to justify the cause of the of the decline of the family. Family values have been replaced by the need for two incomes so we can buy the newest, the fastest, the prettiest, the biggest, and the bestest, in the ongoing, self-imposed, undeclared competition with our peers. Equality and freedom of choice in the family—without direction or leadership—is the cause of family breakdown. When each has an equal voice, each goes in their own direction aimlessly with no leadership. Fundamental principles are cast aside, and each family member goes in a different direction to satisfy their selfish desires, free of responsibility and accountability. Each is allowed and entitled to do “their own thing.”

Sadly, it is the elderly that now suffer. They suffer alone. Once again, big brother has stepped in to fill the void. Once, when families were tethered together with common goals, objectives, and family values, sons or daughters cared for their old and dying. This is no longer the case. It is now the task of the government under the guise of Medicare and Medicaid. A new industry has risen to the forefront. Now dying and death offer a profit motive to the corporate world…and it’s flourishing.

With government and private corporations cooperating, also, come the countless cottage industries of government regulators, private and public sponsored watchdogs, medical specialties, psychologist, and social workers all clamoring to get their piece of the economic pie. All are well-intentioned and overzealous at their new found treasure trough. They are preoccupied performing never-ending studies to enhance their self-interest, the results of which are ambiguous enough to affirm the need for further studies and additional funding—and stimulating their job security.

Without the breakdown of the family, they would all be out of work.



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I ran across this from the National Consumer Voice for Long-Term Care and thought it should be shared.

National Consumer Voice for Quality Long-Term Care shared Max Philisaire‘s photo.

June 28 at 8:44pm ·

This has been circulating on Facebook for some time and has the feel of fiction, yet the sentiment it expresses of “see me for the whole and entire person I am” resonates across all long-term care. What do you think?

When an old man died in the geriatric ward of a nursing home in an Australian country town, it was believed that he had nothing left of any value.

Later, when the nurses were going through his meager possessions, They found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.

One nurse took her copy to Melbourne. The old man’s sole bequest to posterity has since appeared in the Christmas editions of magazines around the country and appearing in mags for Mental Health. A slide presentation has also been made based on his simple, but eloquent, poem.

And this old man, with nothing left to give to the world, is now the author of this ‘anonymous’ poem winging across the Internet.


Cranky Old Man

What do you see nurses? . . .. . .What do you see?
What are you thinking .. . when you’re looking at me?
A cranky old man, . . . . . .not very wise,
Uncertain of habit .. . . . . . . .. with faraway eyes?
Who dribbles his food .. . … . . and makes no reply.
When you say in a loud voice . .’I do wish you’d try!’
Who seems not to notice . . .the things that you do.
And forever is losing . . . . . .. . . A sock or shoe?
Who, resisting or not . . . … lets you do as you will,
With bathing and feeding . . . .The long day to fill?
Is that what you’re thinking?. .Is that what you see?
Then open your eyes, nurse .you’re not looking at me.
I’ll tell you who I am . . . . .. As I sit here so still,
As I do at your bidding, .. . . . as I eat at your will.
I’m a small child of Ten . .with a father and mother,
Brothers and sisters .. . . .. . who love one another
A young boy of Sixteen . . . .. with wings on his feet
Dreaming that soon now . . .. . . a lover he’ll meet.
A groom soon at Twenty . . . heart gives a leap.
Remembering, the vows .. .. .that I promised to keep.
At Twenty-Five, now . . . . .I have young of my own.
Who need me to guide . . . And a secure happy home.
A man of Thirty . .. . . . . My young now grown fast,
Bound to each other . . .. With ties that should last.
At Forty, my young sons .. .have grown and are gone,
But my woman is beside me . . to see I don’t mourn.
At Fifty, once more, .. …Babies play ’round my knee,
Again, we know children . . . . My loved one and me.
Dark days are upon me . . . . My wife is now dead.
I look at the future … . . . . I shudder with dread.
For my young are all rearing .. . . young of their own.
And I think of the years . . . And the love that I’ve known.
I’m now an old man . . . . . . .. and nature is cruel.
It’s jest to make old age . . . . . . . look like a fool.
The body, it crumbles .. .. . grace and vigour, depart.
There is now a stone . . . where I once had a heart.
But inside this old carcass . A young man still dwells,
And now and again . . . . . my battered heart swells
I remember the joys . . . . .. . I remember the pain.
And I’m loving and living . . . . . . . life over again.
I think of the years, all too few . . .. gone too fast.
And accept the stark fact . . . that nothing can last.
So open your eyes, people .. . . . .. . . open and see.
Not a cranky old man .
Look closer . . . . see .. .. . .. …. . ME!!

Remember this poem when you next meet an older person who you might brush aside without looking at the young soul within. We will all, one day, be there, too!”


Thank you…please comment and share.





Bullying puts an emotional drain, not just on the target of such cruelty, but on those that witness such behavior and feel the pain in its presence. The casual onlooker is ill-equipped to intervene. The observer feels uncomfortable yet feels powerless to act. They see the bullying and remain silent. After all, it’s not their responsibility.

I am a witness to bullying every day, and it disheartens me. As I inevitably lose more and more of my understanding, will I become a victim of bullying—when my cognition weakens will I fall prey to taunts and ridicule from those residents around me? It’s a harsh reality on which to ponder as one grows older. I would be naive to think that the nursing home would shield me from becoming a victim. The nursing home staff is either not aware of the subtleties of bullying, or they just choose to ignore them.

Those people closest to the victim of bullying are not the best equipped to recognize and intervene…the trained staff of the nursing home. Other residents are complicit in the act of hurtful behavior toward the victim—joining in on the muffled snickers, laughter, and ridicule—not even aware of their actions.

Even those residents with the severest of disabilities will exhibit bullying on the weakest in the crowd to deflect attention away from themselves. To them, it is a show of strength and membership with the dominant group—a show of solidarity and tacit approval from the powerful. They will join in with their peers, mocking and making disparaging remarks. The most likely targets of such mockery are those that display delusional behavior.

The response from me is only a stern look of disapproval at such conduct.

The responsibility for eliminating bullying must fall to the nursing home administration. Emphasis must be placed on training the nursing assistants in identifying the subtleties of bullying. New hire orientation must include training done by in-house leadership to emphasize the importance. The training responsibility cannot be delegated! Those in leadership positions—department heads—must show their concern, and demonstrate that they are serious about bullying. The administration must be required to share the tools available to identify bullying and be proactive in quelling its pervasiveness. All staff members have to be able to recognize and feel comfortable reporting bullying to authorities without fear of reprisal.

Family members must play and active role. They must ask questions regarding the awareness levels of the administration regarding bullying. What kind of training, what frequency and what follow-up is in place? Inquiries must be made at the time of admission as to staff development programs and where the emphasis is being placed. Nursing homes must be able to document a continuing, comprehensive education and awareness regimen for those employees that come in direct contact with the loved one. Is the training spaced throughout the year or concentrated towards the end of the year to fulfill an administrative requirement? Is the nursing home proactive or reactive in their training program that identifies bullying? What role, if any, does the social worker play in the interaction between residents?  What role does the activities department play? The staff directly involved in activities should be trained specifically in identifying bullying behavior. Observe the activities. Does one resident continually dominate and control the conversation over other residents?  Are weaker residents being ignored or appear to be intimidated during activities or are they encouraged to participate?

All of the questions above will demonstrate whether the nursing home administration is aware of bullying and committed to its control and eventual elimination.








Miguel was born without front legs.  He came from the Dominican Republic to The Mia Foundation in New York.  The Mia Foundation is the only organization in the U.S. that solely rescues animals that are born with birth defects.  Miguel does not let his disability hinder him from living life to the fullest.  He is a happy, fun-loving little boy.

Miguel was born without front legs, He came from the Dominican Republic to The Mia Foundation in New York, The Mia Foundation is the only organization in the U.S. that solely rescues animals that are born with birth defects. Miguel does not let his disability hinder him from living life to the fullest, He is a happy, fun-loving little boy:

Miguel inspires me with his limitless strength and spirit.  A little living being with an abundance of enthusiasm and happiness.  He shows complete disregard for his shortcomings and lives his life with boundless energy and joy.

I have wondered how he can live with a disability without knowing he has a disability.  Is living with a disability a learned behavior?  Someone forgot to tell Miguel that he was supposed to have two front legs.  He must wonder how his playmates function with those appendages hanging from their shoulders.

I have become a paraplegic, losing the use of my legs very late in life, and Miguel is an inspiration—an inspiration helping me cope.  Coping, not with my disability, but with my modified mobility.

Thank you, Miguel.


A disabled veteran








Public rage today is impotent; it has no mechanism to produce consequences.

Glenn Greenwald, With Liberty And Justice For Some, Picador, New York, N.Y., 2011, p. 152.

Shooting rampage in Isla Vista, California

Richard Martinez, the father of mass shooting victim Christopher Michaels-Martinez, speaks to the media on Saturday. Photograph: Michael Nelson/EPA

It saddens us to see the outrage of the father of one of the victims. A victim in the most recent killings in California. An image falling on eyes with short memories. Unfortunately, we don’t share his outrage for long, if at all.

We are not reminded of his permanent emptiness on a daily basis. The empty bedroom; the bed not slept in; the bicycle leaning against the garage wall; the toys no longer strewn all over the living room floor. It’s when the victim is a family member or friend that we express our outrage. Then we feel the anguish, the sorrow, and the daily reminder of loss.

We barely showed our outrage over the killings at Sandy Hook. The horror of Sandy Hook was not strong enough to produce a sustained dialog. Those thoughts were quickly replaced by the joys of our own Christmas experience. Soon the faces were forgotten. The families eventually tried to move on. Some started campaigns to stop the senseless violence, but not many supported the effort to curb the killing that has become an everyday occurrence.

The reality?

Few people care. We are too embarrassed to show our outrage; too politically correct; too afraid to express our deepest feeling; too insensitive to share in the emotions.

We are a nation of people that don’t care. Unless it happens to us, our family, our friend, our neighbor; we don’t care. We have insulated ourselves. The constant barrage of death and despair in the media acts as an insulator. Once we get tired of it, we turn it off, move on, and forget.

The anger and raw emotion demonstrated by the father of a victim may open the wounds of those that have shared his experience, but, in fact, his passionate expression of anguish will quickly be forgotten. Just as those faces from Columbine, Aurora, and Sandy Hook. Images that have faded and been forgotten. Their sadness and outrage are forgotten until the next tragedy.

We are confident that the mainstream media will remind us of the next tragedy in infinite detail.

The next time you walk past your kid’s bedroom and see it a mess, smile and be grateful the child will be safe asleep there tonight. The next time you find the bicycle in the middle of the driveway, get out of your car and move it. Be grateful it’s rider is safe inside the home. Show your love and gratitude, not your anger.

Share Richard Martinez’s sorrow for a brief moment and be thankful it is not you. Be filled with hope that your loved one will not be the next victim of the senseless wave of violence. Then, turn off the thought like the TV, and move on.

Media has conditioned us to forget. We forget because we are helpless.



VETERAN DENIED DIGNITY AND RESPECT: Repost of my thoughts, facts, and opinions expressed on December 29th, 2014. bc




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.


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.


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.


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.




On April 30th, 2015, the administrator of my long-term care facility, and the nurse manager requested entry to my room.  The administrator had an envelope in her hand.  She extended the letter towards me, and I took it.

I read the letter, and I was stunned.

The letter informed me that she had been made aware of my website and took offense. She was requesting that I take the site down from public access.

She was asking that I take down a website that had been up for over a year with many posts of no interest to her. Some were opinions expressed; some were about my adjustment to my new environment, some personal. She was asking me to remove over a year’s worth of work product.

Her letter stated, “Several employees have voiced complaints as the information is inaccurate and employees are mentioned by name in a derogatory manner.” She was careful to add that she had, “discussed this concern with legal counsel in the Attorney General’s office.”  She also gave me a deadline: “I ask that this be done by Monday 4 May.”

The tone of the letter speaks volumes. It was intended to intimidate.

It begs to question: Is it appropriate for a state employee, in an administrative position—a position of power—to exert that power to silence opinions and facts she finds objectionable?

To position one of the Virginia’s most revered institutions off-limits for discussion and criticism is manifestly immoral.


My basic needs are being met with a few additional conveniences. There is no refuge—no place will offer asylum for those that are labeled as one-hundred-percent disabled.  Fear is the curse placed on those that choose to speak up in a long-term healthcare environment.

The use of intimidation is all that is required to suppress objectionable voices.

I have done nothing wrong.  I have the right to “free speech” and can freely express my opinion.  The assertion that my December 29th, post contained “inaccuracies” is false.  What it did contain are facts, observations, and opinions.

The administrator must know because you don’t agree with the narrative that doesn’t mean that it’s inaccurate. The quotes were taken directly from public records. Poor record keeping can be documented by a trail of emails—or lack of emails. There has been no follow-up, no accountability, no consequences, and no dialogue.


The intent of the administration is apparent.  They fear being held accountable and will use every measure available to avoid it…even testing the boundaries of free speech.

Nothing is beneath them.