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One thing the virus has done is create broad agreement – across the states, the VA, among families of patients – that something needs to be done. Homes need clearer lines of accountability, whether state, federal or shared. Fixes to aging physical plants will help fight infections, but the blame won’t just bubble on its own, as homes are being renovated with private bathrooms and negative pressure rooms.
Most believe that an increased federal review is essential.
GAO in 2019 and 2020 focused on these annual inspections, outsourced to a contractor. “VA officials said they were not following or monitoring the nature of the recommendations or whether they had been addressed,” GAO wrote in 2020, after the pandemic began. “As a result, VA does not have complete information on all breaches of quality standards in SVHs and cannot track this information to identify quality trends in these homes.”
The VA said in February it would demand that all shortcomings be documented and rectified. In an emailed statement, he said his “modernization plan … will lead to improvements in efficiency, standardization, collaboration and quality improvement.”
The GAO also blasted the VA for not making quality information accessible. Even though the homes are state-run, he said, the VA is the only agency that inspects them all “and, therefore, is the only agency that could share such great information on its website. “.
Since then, the VA has made more top issues available to the public, but they are still incomplete, hard to find, and don’t seem to match the more specific CMS database that the agency is linked to on the same page.
The lack of progress alarmed members of Congress.
“The Covid-19 pandemic has hit our homes of state veterans particularly hard and has highlighted issues with VA’s limited oversight authority over them,” wrote Rep. Mark Takano (D-Calif .), chairman of the House Veterans Affairs Committee, wrote POLITICO in an email. Despite the recent infusion of funds, Takano remains concerned about post-pandemic care and whether the VA should do more. It is considering legislation to expand CMS oversight, set standards for construction and renovation, and require homes to be managed by licensed long-term care administrators.
Advocates, including Porter of the Iraq and Afghanistan Veterans of America, want Congress to be much more prescriptive on lines of authority than it was in spending bills, which were primarily about money and construction.
Schwartz, who helped write the report for Vietnamese veterans of America, said nothing will really change until the system gets more serious about meeting standards. These standards exist in theory, she said, but they are too often obscured in reality.
Shulkin, the former secretary, is still proud of the agency he once ran, and believes officials there have started to tackle the deficiencies in homes and are making strides in both quality and transparency. But figuring out how to reconcile state and federal roles is problematic. He would like state and federal agencies to hold a political summit to chart the way forward, especially as the Vietnamese-era generation ages and more veterans will need long-term care in near future.
“How can we do better for vets? How do we work together? This fragmented system is no secret, ”he said.
Some state officials, like Oklahoma’s Kintsel, said he often turned to the local VA medical center for help, and that he also welcomed a greater state surveillance: health department. We are not afraid of being scrutinized.
The Hawaii Representative’s case tends to maintain a state-federal mix, but he’s still pondering what that balance should look like after the tragedy in his hometown. States can and should operate in an environment they know best, but VA also has something to offer. Everyone must find how to share the responsibility – and not just share the blame, of which there is more than enough for everyone.
“I’m reluctant to conclude that you reject the partnership,” Case said. “But do you have a better alternative? This is what I have to ask myself.
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