Security data gaps remain on state veterans’ homes

Homes are suffering in what former VA secretary David Shulkin called a “hodgepodge” of state and federal oversight, with loopholes in regulation and accountability, a Politico investigation five months earlier showed This year. The VA pays for the houses and orders an annual inspection; the states own them and use them on a day-to-day basis. Some states require that they meet the same standards as civilian long-term care facilities; some do not.

The death rate from Covid-19 in public homes was much higher than in a separate type of long-term care for veterinarians, known as community living centers, which are run entirely by the VA.

The Veterans Administration, which sent emergency teams and resources to veterinarians’ homes and civilian health facilities at the height of the crisis, recognized it had to do better.

A report published this month the assessment of the VA’s overall national response to the pandemic recommended developing “an information system to facilitate monitoring of state veterans’ homes for infectious disease risk indicators”. He also said he was “working to become more proactive in support of SVH”. However, the report did not cite any specific plan or timeline.

Congress took note, pushing for greater transparency and investing an additional $ 1 billion during the pandemic, aimed at repairing and replacing dilapidated buildings with poor infection control. But lawmakers have not systematically addressed a permanent solution to divided state and VA oversight.

The collection and dissemination of data reflects and amplifies this fragmented authority and responsibility. The 158 individual households, national health and veterans agencies, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the VA itself all have a role to play in collecting the numbers; none has supreme authority. When a house does not report its numbers for a given week, the VA simply types “—“. In some cases, statistics circulated by states do not match those published by the AV.

The data is important, say experts in epidemiology and long-term care.

Data is more than numbers on a spreadsheet, they say. It’s a window into the quality of care, skill and resources put into controlling the spread of a virus that has killed one in 100 Americans over the age of 65 – and it’s turning into a winter wave that could in kill more. Flawed data means it is more difficult for outside groups – veterans’ advocacy and service organizations, families, the media, even other government officials – to hold homes accountable for procedural breaches. security.

About three-quarters benefit from CMS supervision, and their the data is published. For months, it has been difficult to find data for the roughly four dozen houses that do not fall under the CMS. In mid-November, the VA began publishing much more detailed information on infections and deaths of staff and residents of homes in all 50 states. But the VA does not collect the data itself. Rather, it depends on what homes and states submit – and some is always maimed or delayed.

Homes understand that more needs to be done, their national association said.

“State homes have resolved the discrepancies on an individual basis as they are identified,” said Heyward Hilliard, president of the National Association of State Veterans Homes. “Within the state’s home community, there have been some variances in the criteria and reporting methods leading up to the current datasets. As these are resolved, the number should be fine. “

It hasn’t happened yet, not at all levels.

For example, publicly available data from the VA shows no deaths in homes in Missouri from May 25, 2020 to August 29, 2021. This is incorrect – Missouri itself reported 103 Covid deaths in mid-November 2020 , and ordered a report by St. Louis-based law firm Armstrong Teasdale on missteps and how to fix them. This report has been made public.

Missouri State Veterans Agency spokesperson Aimee Packard attributed the inconsistencies to technical issues. “We are actively working with the VA on a historical data upload issue that is affecting our case count between the onset of the pandemic and approximately January 25, 2021,” she wrote. As of earlier this month, Missouri had recorded no deaths from Covid at its state veterinarian homes in 2021, she added.

In Mississippi, a state Veterans Affairs spokesperson shared data with POLITICO earlier this fall that showed its four homes had 434 cases and 111 deaths between April 2020 and September 22, 2021. He has shared state totals, not a site-by-site breakdown of homes, which can serve 600 people at any one time. But the VA site shows a maximum of 87 cases and 10 deaths between May 25, 2020 and September 29, 2021.

Illinois makes its counts available on a state website, but these numbers do not match the VA site. For example, a status report said the LaSalle, Illinois home had an outbreak that began in November 2020 and caused some 109 cases among veterans and 116 among staff. On the other hand, the VA card showed 10 cases for patients, 18 for staff. At the Manteno, Illinois home, 48 veterans and 33 employees fell ill during an outbreak between early May and June 2020, state records show. The VA shows that 31 employees and at most 10 veterans fell ill there between May 25, 2020 and September 2021.

A spokeswoman for the Illinois Veterans’ Office said she had no explanation as to why the VA numbers were wrong. The state had submitted correct figures and its local liaison with the federal VA had confirmed their accuracy. “We do not know why this report does not reflect the exact data,” she wrote.

Several other states have anomalies. But in other cases, reports improve. For example, data from Nebraska was missing earlier this fall; it fits now.

For political leaders and veterans advocates, the struggle for complete and accurate information on cases and deaths has been a long and frustrating one.

“On behalf of the men and women who have served our country, I will continue to work with my colleagues on both sides of the aisle to hold the [VA’s] Feet on the Go to Provide Complete, Accurate, and Timely Data to Congress and the Public, ”Chairman of the Senate Veterans Committee Jon tester (D-Mont.) Told POLITICO in an emailed statement. “This is how we make sure states and VAs provide the best possible care for veterans.”

As of May 2020, CMS has required long-term care facilities to submit data to the CDC – illness and death rates for residents and staff.

CMS has started publishing information on civilian nursing homes as well as the veterans’ facilities it oversees. But the agency said it was not responsible for publicly disclosing the roughly four dozen veterans’ homes it did not regulate. Most of them were “home-based” establishments, which are more like assisted living facilities. (Some houses had a mixture).

Congress in a sweeping appropriations bill passed in late 2020 demanded that the VA fill this gap and report all data from veterinary outbreaks in the state. But the legislation was not clearly written; the VA insisted for months that it only had to report aggregate totals, not a house-to-house breakdown. Almost a year later, under pressure from Congress, and as POLITICO reached out to every household where data was lacking, the VA began to disclose.

House and Senate veterans committees pushed VA and government accountability The office examines the oversight and transparency of the VA. But it has not become a major problem for Congress as a whole.

“VA and states have a shared responsibility for overseeing the quality of veteran care in state veteran homes, and we need greater transparency around this oversight,” Tester added in his statement.

But so far the VA hasn’t signaled much of an appetite for change. When the senator Chuck grassley (R-Iowa) earlier this year, VA Secretary Denis McDonough sent out a list of questions about surveillance. . “

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