ONCE AGAIN WE MOURN, ONCE AGAIN WE’LL FORGET: RE-POST FROM MAY 31, 2014

 

OUTRAGE

MAY 31, 2014 LEAVE A COMMENT EDIT

OPINION:

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.

bc

OUTRAGEVIOLENCE

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.

*

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.

bc

OPINION: DIGNITY, RESPECT, AND FREEDOM OF SPEECH DENIED

OPINION:

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.

LOST IN TIME…LOST IN SPACE

 

Toward the end of July, 2011, I began having back and abdominal pain that progressed from mild to extreme.  Four trips to the emergency room at McGuire Veterans Hospital provided no relief.  In desperation, and to avoid a wait time in the ER, on July 28th, I called an ambulance to pick me up at home.

Somewhere, during the trip to the ER, my mind went blank. I have no memory of being admitted to the hospital.  I have no memory of staying six nights.

My medical records show that seven days later, on August 3rd, I was transferred to Sitter and Barfoot Veterans Care Center.

Sitter and Barfoot is a veterans’ long-term care and rehab center. I had never heard of it.  I have no recollection of being included in the decision process. No family members participated in the decision to move me to a nursing home.

I’ve been told that I was discharged from McGuire on my own and arrived at Sitter and Barfoot by taxi. I have no memory of a cab ride. I completed the admitting paperwork but don’t remember doing so.

I have vague recollections of being in unfamiliar surroundings, being restrained in a bed at night with bolsters on both sides and with an attendant.  I have no idea why I was restrained other than being a possible flight risk. Staff members have told me that I was aggressive, delusional, and hallucinating.

In September, seven weeks later, I was scheduled for back surgery, returning to McGuire for a laminectomy at T-8 and T-9 vertebrae. I have no memory of the discharge from Sitter and Barfoot and being readmitted back to McGuire. The surgery was performed on September 22. I have been unable to stand or walk since.

My medical chart shows that on 10/26/2011, Kathryn L. Hall, a social work student wrote:  “When asked about his IDT [interdisciplinary team] meeting yesterday, the patient said that he understood he would not be able to return home, but hopefully will be able to return to Sitter & Barfoot.”

It remains unclear who was “hopeful.”

Ms. Hall was under the supervision of Thomas Olivieri, MSW.

I stayed at McGuire Hospital until December 9th, 2011, receiving various antibiotics, therapies, rehabilitation, and consults from a variety of medical disciplines.

Returning to Sitter and Barfoot was the only option offered, and I knew of no other comparable facility.  My previous experience at Sitter and Barfoot was unremarkable.

The social workers at McGuire glossed over the fact that I would have to switch from being treated under the Veterans Health Administration and change to Medicaid. I would lose all of my possessions; all retirement income less $40.00/mo personal needs allowance, and my best friend.

Even though the prognosis was grim, I remained optimistic about the future and refused to accept the fact that I would never walk again.

I did not comprehend the long-term consequences regarding the direction the social workers pushed me.  In retrospect, the options presented to me were end-of-life decisions—at the young age of 69.

*

I will spend the rest of my life in a nursing home where if feel constrained. I was coerced into a controlled environment and had to surrender my independence; placed in a closed social structure that was foreign to me. I found myself surrounded by persons, not of my choosing, many experiencing cognitive decline, some inconsiderate, and others too loud for my liking.

The few residents that I had formed a friendship, sadly, have died. I stopped trying to replace them.

*

Residents are encouraged to decorate their rooms for a personal, home-like feel.  Social activities offered are designed to entertain and provide a distraction for all age groups and abilities: Scattagories, Pictionary, Bingo, Trivia, Dominos, art classes, current events, music, etc.

Often residents remain alone with their thoughts, blankly watching TV or staring out at emptiness trying to recapture fading memories.

These conditions serve as a view into my future.  These conditions are what I will become. It is all too clear.  This is what I have to look forward to. It’s not a pretty picture. Those around me are in some stage of slow decline. It serves as a continual reminder of the futility of it all.

*

Through education and perseverance, I prepared myself to regain some autonomy that was initially denied.  I have been able to expand my boundaries and travel to downtown Richmond by city bus.

Although Richmond is a friendly city for those with disabilities, the bus schedule is less accommodating. Destinations of interest often require transfers and long waits. Weather is a major consideration, requiring advance preparation, often forcing a disappointing change in plans.

My independence is limited by my power wheelchair, city bus, and economic constraints. Still, I take pleasure in the occasional excursion downtown. My ability to come and go is hampered only by my physical affliction, financial hardship, and climate conditions.

*

I have a private room. I have my laptop. I have my music, and I am left alone to pursue the only thing of interest—writing.

I hope, as I move forward, my thoughts and opinions will reach those that share the same interests.

 

bc

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

AN OPEN LETTER TO CONGRESSMAN ROBERT C. “BOBBY” SCOTT

 

VETERAN

February 9, 2015

Congressman Robert C. “Bobby” Scott
1201 Longworth House Office Bldg.
Washington, D.C. 20515

Dear Congressman Scott:

Ms. Ranicki, the Administrator at Sitter and Barfoot Veterans Care Center, validated all of my assertions. It begs to question why such policies and practices existed.

Unfortunately, my sphere of influence does not extend far. Many of the veterans at Sitter and Barfoot experience the same indignities but are unwilling, unable, or too fearful to raise a voice. It would be naive to think otherwise. It is for those veterans that I also raise my voice. Hopefully, others will hear my truth and implement much-needed reform.

Despite the oppression exerted by Sitter and Barfoot, I have persevered, and by attacking the tyranny of the administration and Sitter and Barfoot, I have been able to improve my end of life experience. I continue to pursue my dreams, to fulfill a life packed with purpose and meaning—despite Sitter and Barfoot and my disability.

I will not be silenced. I will continue to make others aware of the indignities I’ve suffered; a veteran that served to protect the very rights I’ve been denied.

It is shameful that the noblest of institutions has failed me in so many ways. An aware, concerned, responsive, and dedicated administration would never allow such practices under their purview. Ageing veterans deserve leadership that manages with integrity, transparency, and by example.

The prevailing culture at Sitter and Barfoot is one of control. Not only control over the veteran resident, but control over the counterfeit image projected to the public.

I too, invite you or your representative to visit me at Sitter and Barfoot. It is a beautiful facility. Sadly, it is the epitome of the axiom, “Beauty is only skin deep.” Come visit and we can review several years of enlightening health department inspections.

Thank you.

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.

*

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.

*

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.

bc

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.

bc

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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