WASHINGTON (AP) — Big gaps in federal oversight of long-term care facilities for aging veterans may have contributed to rampant coronavirus infections and more than 200 deaths at state-run homes, according to a congressional watchdog agency.
The Government Accountability Office found the U.S. Department of Veterans Affairs failed to require robust inspections at the 148 state-run veterans homes nationwide and to make sure all deficiencies were rectified, even as it regularly doled out federal dollars for the care.
That likely made a bad situation worse in places like the Soldiers' Home in Holyoke, Massachusetts, one of 50 veterans homes nationwide where VA is the only federal agency monitoring it, according to GAO. A recent investigation conducted for the state of Massachusetts found the superintendent there was not qualified to run a long-term care facility, and that officials with a state agency were aware of his "shortcomings," but failed to do enough about it.
By law, VA is barred from making federal payments until facilities meet standards of quality care.
"VA needs to continue to strengthen its oversight," Sharon Silas, director of health care at GAO, told a House hearing Wednesday in written testimony. Her team is conducting a wider investigation of VA's oversight into the facilities in light of surging coronavirus deaths.
"It is imperative that VA ensure the health and safety of these veterans," she said.
At least 158 residents of the 278-bed Massachusetts facility, or 57%, have tested positive for COVID-19. At least 76 residents have died. Similar outbreaks have occurred in New Jersey, where more than 80 have died due to COVID-19, as well as Pennsylvania, more than 40, and elsewhere.
Lawmakers said they found it troubling that GAO urged VA more than a year ago to address problems of lax oversight, but got little response. VA now says some of the fixes could take two years or more.
"As it stands now, I have to wonder: how many lives could have been saved at state veterans homes during this pandemic if there had been stronger, more consistent oversight on the part of VA?" said Rep. Mark Takano, D-Calif., who chairs the House Veterans Affairs Committee.
"Clearly, we have not done enough as a nation to ensure nursing homes were ready for this pandemic," he said.
In response, the VA said it has been committed to ensuring quality care but insisted that it has no control over state-run facilities. The agency said that as early as March it was holding town halls, providing informational checklists and other guidance to the veterans homes and ultimately sent hundreds of VA doctors and nurses to assist the state facilities.
In contrast to those facilities, nursing homes fully operated by VA have had few infections after the department early on imposed lockdowns and other safeguards to keep the virus out of facilities, it said.
"During COVID-19, VA has continued to serve veterans, their families, caregivers and beneficiaries and has filled a critical role in the nation's response," said Dr. Teresa Boyd, a VA assistant under secretary for health.
Rep. Julia Brownley, D-Calif., who heads the House Veterans Affairs subcommittee on health, said she wasn't so sure.
"There should not be two different standards of care," she said. "We have a moral and ethical obligation to ensure that residents of state veterans homes are afforded similar access to safe, high-quality care and protections during this pandemic."
In all, about 40,000 residents of long-term care facilities nationwide, both veteran and non-veteran, have died of COVID-19—accounting for an estimated 40% of all coronavirus deaths in the U.S. But it's not known how many of these happened at state-run veterans homes because not all of them are required to report coronavirus infection and death rates to VA.
The Centers for Medicare and Medicaid Services provides oversight for about two-thirds of state-run veterans homes that receive Medicare or Medicaid payments.
According to GAO, VA was lax with inspections and allowed a contractor to classify potential safety problems at veterans homes that were seen as "minimal harm" as a recommendation, rather than a deficiency. VA also allowed the contractor to grant on-site corrections so a veterans home could avoid a formal citation. As a result, from 2017 to 2018, VA's contractor cited zero deficiencies at 49% of the veterans homes it inspected. Based on a test sample, GAO also found VA cited fewer deficiencies than CMS on the same five facilities which they both had inspected: seven deficiencies compared to CMS' 33.
Citing a need for greater transparency, GAO last year urged VA to post quality of care data on its website, much in the same way CMS does for all the facilities it reviews. According to GAO, VA said it will explore options but would not have anything completed until at least July 2022.
VA pays over $1 billion each year to state-run facilities to care for 20,000 of the nation's veterans, representing over half of the 39,000 veterans that receive VA-funded nursing home care.