NEAL P. GOSWAMI
BENNINGTON -- The Vermont Veterans Home is again in compliance with federal regulations and will not lose Medicare and Medicaid funding, ending a looming disaster that would have disrupted the lives of residents, staff and the community.
Home Administrator Melissa Jackson said she and others were given verbal assurance Wednesday morning from the Vermont Division of Licensing and Protection that the home had passed a last-chance inspection. Jackson said she is still awaiting official written notification, but state and federal officials have been notified that it is forthcoming.
The Board of Trustees revealed earlier this month that the facility faced decertification because of issues identified during several inspections since March. The state-run home had to correct at least three deficiencies, including an alleged assault of a resident by a nurse, that were identified by inspectors. The division serves as an agent for the Centers for Medicare and Medicaid Services (CMS), which had threatened to cut off about $12 million in annual funding if the home did not pass another surprise inspection by Sept. 28.
CMS funding accounts for more than half of the home's operating budget. Losing federal funding would have meant that about 100 of its 155 or so residents would have been relocated elsewhere.
The home had been operating for weeks under a dark cloud of uncertainty. Residents were unsure if they would be forced to move to other facilities. And workers were unsure if they would be able to keep their jobs if federal funding was terminated.
But the mood inside the facility on Wednesday was considerably lighter.
"It's a big relief for all of us because we didn't know where we were going to go," said Jim Hewitt, a resident who serves as president of the resident council. "You're talking about moving over 100 people. If they closed this down, what would've happened to us?"
Staff and management were feeling relieved, too.
"It's been like a big burden has been lifted from us. By no means are we letting our guard down," Jackson said. "I think the greatest thing I see is the veterans going around and congratulating the staff and saying, ‘See, I knew you could do this,' and just how supportive they were."
Board of Trustees President Joseph L. Krawczyk Jr., a retired Army colonel, said the board, administrators and staff had worked diligently since finding out earlier this month that the future of the home was in doubt.
"The last two weeks, obviously, has been a full court press," he said. "We were doing the right things to make sure we'd find out what found out today at 11 o'clock, that we were in compliance and we won't lose our funding."
Residents of the home were expressing their joy Wednesday that their home would not be closed or scaled back in size, according to Krawczyk.
"I mean, you talk about jubilation. The patients are going crazy. They were our biggest cheerleaders during this whole thing, our resident veterans. They didn't understand what was going on, why it was going on. They didn't believe what they heard. I'll tell you, this is there family and they know it."
The trustees are now working to put measures in place that will prevent the home from experiencing any similar close-calls in the future.
"We're going to make sure now that they're up and they're running, and we've got an audit system to make sure they're running. We've got a new education system that we're working on right now," said Krawczyk, who assumed his position the same day the home's troubles were made public.
Members of the Shumlin administration, as well as the state's congressional delegation, have been involved in trying to help the facility turn around. Jeb Spaulding, the secretary of Administration under Gov. Peter Shumlin, said he and others have assisted, but have not been in direct control of the facility because of the "rather unusual governance situation."
The home has a board and an administrator, both appointed by the governor. However, director oversight of the home is the responsibility of the board. The state may look at that structure "and consider if it really makes sense for the long term," Spaulding said.
Spaulding said he personally contacted CMS officials "just to let them know what we were doing to assist in the situation." And, the congressional delegation "let the folks at CMS at their level know that this was our one veterans home." Everyone was pushing for one more inspection of the facility, he said.
"I do think the fact that the administration got actively involved was helpful with the view from Boston and Baltimore with CMS," Spaulding said.
Still, CMS's decision to continue providing funding to the home was the result of the work done on the ground in the last two weeks, he said.
"Whether the interest of the governor or the congressional delegation contributed to the one more chance to address the deficiencies, I guess we'll never know," he said. "I actually do think what really made a difference to them was not who was getting involved, but that steps were taken."
Several personnel changes have already been made. Assistant Administrator Karen Woodcock was fired by the board last week. A nurse who caused one of the deficiencies by improperly changing a dressing on a wound has been placed on administrative leave, according to a person familiar with the changes.
Additionally, a licensed pratical nurse facing a misdemeanor assault charge for allegedly punching a resident in the nose, is also on leave.
Jackson, who was appointed by former Gov. James Douglas, continues to enjoy the support of the board and the Shumlin administration.
"We offer our full support for Melissa Jackson. I think the way she handled the situation is a real feather in her cap," Spaulding said. "I think Melissa Jackson deserves a lot of credit for not being defensive. It actually speaks very well of the management at the veterans home that they were open to assistance and they will continue to be."
But, the home is likely to be "under heightened scrutiny by the regulatory bodies" for the foreseeable future. The staff and management at the home will have to continue their efforts to improve, Spaulding said.
Spaulding also praised the efforts of Krawczyk to address the tenuous situation at the home since being elected to serve as president of the board.
"The governor is very pleased that Joe Krawczyk is the chairman of the board," he said. "Joe has been at the veterans home every day since he became chair and that is very helpful."
Other changes are also under way at the facility. Jackson said she is working to revamp the education process for the nursing staff. "Our education process has been: Here's a new policy, read it and sign it," she said.
"It's a top down look at everything we do here so that we don't end up in this situation again," Jackson said.
And the Trustees are looking into securing leadership training for supervisors, Krawczyk said.
Relations with the Vermont State Employees Association are also being addressed. Krawczyk said he has committed to meeting with union officials monthly to improve communication.
The union has raised concerns with staffing levels over the past several months, saying forced overtime was leading to the deficiencies. State Commissioner of Human Resources Kate Duffy said Wednesday that she is working with the union to create a new staff schedule. Union officials said they are pleased with the collaborative process, but still have concerns with the set schedules the state is seeking.
Meanwhile, the use of non-union contract nurses could become an issue. Krawczyk said "independent staff" authorized by Duffy are beginning to work in the building alongside union members.
"They don't like it, but it's not forbidden, either," Krawczyk said. "I'm more concerned that we have staff to provide the care."
The long-term plan is to have a permanent staff in place "that's functioning 365 days a year," he said.
VSEA Spokesman Doug Gibson said the use of outside nurses indicates that staffing levels are not right. Still, the union is committed to coming to terms on a new scheduling system.
"Hopefully we can come to an agreement that is satisfactory to everyone involved and we can solve these staffing issues. We're not convinced they are scheduling issues. As much as they want to label these scheduling issues, we're not convinced. We do think the fact that they are bringing in traveling nurses, or per diems, indicates that there is a staffing issue and they are addressing it by bringing in temporary staff," Gibson said. "We recognize that this is a crisis and they needed to do what they needed to do. We're happy we've arrived at where we're at, but there's still a lot of work to do."
Spaulding, too, said there is more work to be done.
"I'm hopeful and optimistic that the morale at the veterans home has started to improve and if we demonstrate that this was not a short-lived commitment to quality, that we will continue to see morale improve," he said.