NEAL P. GOSWAMI
BENNINGTON -- The Vermont Veterans Home Board of Trustees said Wednesday that the facility is facing the "doomsday" scenario of losing crucial federal funding unless several deficiencies identified by the state's Division of Licensing and Protection are corrected within the next two weeks.
At risk is $12 million in funding from the Centers for Medicare and Medicaid Services (CMS), the Trustees revealed at a quarterly meeting Wednesday, because of the deficiencies identified by the state, which serves as the survey agency for those federal health insurance programs. That funding represents more than half of the home's budget and could spell the end of the home, according to Michael LeBoeuf, head of the trustee's Finance Committee.
According to a letter from CMS to Veterans Home Administrator Melissa Jackson, dated Aug. 2, CMS has already cut funding for new patients at the home, but has continued payments for existing residents.
According to LeBoeuf's report, deficiencies identified during a May 31 survey remain uncorrected. New deficiencies were identified in a Sept. 5 survey, he said. As a result, the home faces the termination of its provider agreement with Medicare and Medicaid on Sept. 28 that would cut funding for existing residents after 30 days.
"The nursing home would lose approximate $1 million per month. As far as I can see, the nursing home could not sustain that," he said. "I don't know how far we can go."
The home, which currently has about 155 residents, would have to find placement for the 100 residents that are covered by Medicare or Medicaid. Moving that many residents to other facilities would take 30 to 60 days and cost the home an additional $2 million, LeBoeuf said.
"The numbers just don't work. Nothing in this day and age is free and we have to make up the million dollars somewhere," he said. "I don't see it in the cards that we can make up a million dollars a month."
The impact of losing Medicare and Medicaid funding was laid out in stark terms by outgoing trustee President Laura Corrow.
"If we're put back into compliance then these horrible letters from CMS will not come to fruition. If we're not found to be in compliance, then this doomsday starts," Corrow said. "We've got one more chance, basically, to be brought back into compliance. If that fails, this takes effect and we don't have any repercussions or anything else that we can do."
Veterans Home Administrator Melissa Jackson said the surveys turned up several deficiencies, including failure of medical staff to report medical conditions to physicians, and failing to report abuse in a timely manner, among other issues.
The challenges facing the home has led to tension between staff and administrators for months. The deficiencies, according to the Vermont State Employees Association, are the result of insufficient staffing to cover all nursing shifts. VSEA Executive Director Mark Mitchell attended Wednesday's meeting and said the union has been working with administrators to fix scheduling issues and ease discord.
"We've been unsuccessful and things have been left uncorrected. They've snowballed. There are months and months of citations," Mitchell said. "It's rather extraordinary, but our union is committed to turning this place around. I know that our union will do everything possible to keep this facility open and functioning and as big and as robust as it needs to be."
Mitchell said state officials -- who are now involved in addressing staffing and scheduling, as well as finances -- and the union must now find ways to address staffing levels.
"We need to get on the same page about getting enough nurses and caregivers in the building to provide the care that management has decided, and we agree, is needed," he said.
However, Vermont Department of Finance and Management Commissioner James Reardon said Mitchell's comments were a mischaracterization of many of the issues identified in the facility surveys.
"All but one of those citations have nothing to do with the level of staff. They have to do with deficiencies based on inaction, or action by the staff member that was present at the facility. So, it was not a staffing issue. Let's be clear about that," Reardon said.
He also cautioned trustees and the union that the state may not be in a position to cover the lost funding if CMS does pull funding. Therefore, working together to solve the issues is paramount, he said.
"I have not yet spoken directly to the governor relating to issues at the Veterans Home, but I can tell you that the governor obviously supports veterans, but there is an economic reality, too. The economic reality is the state is still fiscally fragile. And, to make the assumption that the state can automatically backfill for any lost federal funds might be a huge miscalculation on anybody's part. So, that's the reason why I hope we don't get to that point given the fiscal issues the state's confronted with.
The state has hired an outside consultant to review staffing levels at the home, according to Vermont Department of Human Resources Commissioner Kate Duffy. But, a review by state officials has shown that there are sufficient staff members to cover all shifts.
"That's not to say that there may not be some issues of concern. What really seems to be a concern is this is more of a scheduling issue than a staffing issue. There is uneven staffing. We are working to change that," Duffy said. "The reality is, we've been speaking with the VSEA, we will continue speaking with the VSEA."
Duffy also said staffing levels are not to blame for the deficiencies that must be fixed.
"I don't believe that staffing has played a role in any way in the CMS citations. And, I think that what we need to focus on today, right now, is making sure that we come back into compliance and that we focus on the day-to-day nuts and bolts of what we do. Once we can do that, we can talk about staffing and we can talk about issues. But, right now, we're not going to be talking about anything in a few weeks if we don't make sure that we all pull together," she said.
Corrow, who has planned on stepping down from the board for over a year and will soon move out of state, apologized for the timing. "It's so hard leaving with this crisis. I'm so sorry. I know it's going to turn around because you guys care more for the veterans than you care for yourself. I know that," she said.
New Board of Trustees President Joseph L. Krawczyk Jr. said he is prepared to face the challenges ahead at the veterans home. "I'm not going to walk away from a challenge," he said.
Krawczyk, who also serves as chairman of the Bennington Select Board, said about $4.3 million in payroll could be pulled out of the local economy if the deficiencies are not corrected in time. Those issues will be addressed quickly, he said.
"There's a handful of people on the staff here that are creating 99 percent of the problems. The other employees are top notch," Krawczyk said.
Meanwhile, Jackson said action is already underway to ensure the home meets all requirements during the next survey. "We are continually, constantly reeducating our staff on those areas that we were found deficient," she said.
Although disagreements exist over the cause of the problems, everyone is feeling the pressure to fix it.
"We have two weeks. If we can't get compliance back, I hate to see what will happen," LeBoeuf said. "These next two weeks are going to make us or break us."