In the News

AT A CONGRESSIONAL HEARING on Wednesday, the Holyoke Soldiers’ Home was held up as a model – a model of what can go wrong when an odd state-federal relationship leaves gaps in who exactly is responsible for the home.

The COVID-19 outbreaks at the Holyoke Soldiers’ Home and other veterans’ homes throughout the country have spurred calls for the US Department of Veterans Affairs to take a more hands-on role in assisting state-run veterans’ homes. But federal officials say they intentionally leave home affairs up to the state.

Paul Barabani, the former superintendent of the Holyoke Soldiers’ Home and a member of a coalition formed to advocate for improvements at the home, testified Wednesday via video at the hearing by the Committee on Veterans’ Affairs’ Subcommittee on Health that examined oversight of state veteran homes during the COVID-19 pandemic. Barabani asked the VA to provide more assistance and guidance to soldiers’ homes.

“Let’s collaborate and use their resources to help us with solutions to deficiencies we may have,” Barabani said in a conference call with reporters after testifying.

But Teresa Boyd, assistant undersecretary for health for clinical services at the Veterans Health Administration, said at the hearing that the department defers to states for day-to-day decisions. “It is state-run and we do respect the autonomy of the states with regard to operational oversight,” Boyd said.

At the Holyoke Soldiers’ Home, 158 residents in the 278-bed facility tested positive for COVID-19, and 76 of those residents died. State officials replaced the home’s leadership and brought in new leaders and National Guard support. Secretary of Veterans’ Services Francisco Urena resigned. An independent review found significant mismanagement.

US Rep. Richard Neal, a Springfield Democrat who chairs the House Ways and Means Committee and has an uncle at the Holyoke Soldiers’ Home, said the hearing grew out of conversations he had with Veterans Affairs Committee Chair Mark Takano, a California Democrat.

Barabani, a retired National Guard colonel, was appointed to run the Holyoke home in 2011. He retired in 2016, saying state officials failed to provide adequate funding for the home. He complained about a lack of money to hire staff and a failure to implement plans to renovate the home.

In his testimony before the committee, Barabani highlighted the conundrum facing homes like the one in Holyoke, caught between federal oversight and state control – what Neal called a “hybrid” model. Typically, day to day operations at soldiers’ homes are left up to state government, but they are inspected by the US Department of Veterans’ Affairs to make sure that they adhere to VA standards. The VA and the state both provide funding.

In 2010, Barabani said, a VA survey of the home reported that fewer than 5 percent of beds met the standards for safety and room size. Barabani and his staff developed a plan to build a new wing with 120 private rooms and renovate the existing building to provide more private or semi-private rooms. The VA approved a grant for the plan in 2013, but the state never provided necessary state money.

“The coalition believes the lack of sufficient staff and overcrowded rooms were root causes of the rapid spread of the virus,” Barabani said.

Barabani said another review of the home conducted in January 2020 flagged a lack of infection control procedures – although that may have only applied to an area of the facility where residents lived together with minimal assistance rather than the nursing home.

“Imagine if the (local VA facility) and the home worked collaboratively to implement a policy in the month of February,” Barabani said.

In a call after the hearing, Barabani said federal veterans officials should collaborate more with state-run homes. Currently, he said, a federally hired contractor conducts an inspection, then leaves it to the home to fix deficiencies.

Barabani said the local Veterans’ Affairs facility should instead use its expertise to help the facility craft a corrective action plan. He said Soldiers’ Home staff should have access to federal services like training and disaster preparedness planning, and federal experts could assist with crafting infection control procedures. The VA could also lobby state officials when, for example, a major construction project is needed to address recurring deficiencies., he said.

Between 2013 and 2016, Barabani said, “I needed the VA’s help to influence state decision-makers to provide funds for proper staffing and renovation of the home to ensure quality veteran care. I often ask what if they listened to my request for additional staff, for individual rooms in the renovation, how many deaths may have been prevented if they had listened and acted?”

Today, the main tool the VA uses to ensure homes comply with its standards is a threat to withhold funds if a home does not comply. Subcommittee Chair Rep. Julia Brownley, a California Democrat, called that “a tool…not a solution” to ensuring high-quality care.

“I have to wonder how many lives could have been saved at state veterans homes if there had been stronger, more consistent oversight on the part of the VA,” Takano said.

But Veterans Affairs officials question whether they have a larger role to play. Boyd said the federal agency does provide assistance to state soldiers’ homes – for example, during the pandemic, it has given homes personal protective equipment and training. But she said the operational functioning of the home “is in the lap of the state.”

US Rep. Neal Dunn, a Florida Republican and the subcommittee’s ranking member, said state-run veterans’ homes are “clearly run by the states.” While acknowledging that the VA has a “special relationship” with the homes, he said, “Ultimately it’s the states, not the VA, who’s responsible for day-to-day oversight.”

The hearing also provided insight into a regulatory quirk that results in the Holyoke Soldiers’ Home getting less scrutiny than most other soldiers’ homes in the country. Of 148 Soldiers’ Homes that receive VA money, 107 have Medicare or Medicaid contracts, so they are inspected by the VA and the US Centers for Medicare and Medicaid Services. Most are also licensed by their states and must meet state standards.

The Holyoke Soldiers’ Home is not licensed by the state Department of Public Health and does not have a contract with the Centers for Medicare and Medicaid Services, so its only oversight comes from the VA.

Sharon Silas, health care director for the US Government Accountability Office, said only a “handful” of homes are in that position.

The VA-hired contractors who perform inspections have somewhat looser standards for inspections than CMS, according to the US Government Accountability Office. For example, they let inspectors list low-level deficiencies as recommendations, and let homes make repairs while an inspector is on-site to avoid getting a deficiency.

The independent report by attorney Mark Pearlstein investigating the Holyoke Soldiers’ Home COVID-19 outbreak said the home is inspected annually by the VA and every three years by an accrediting agency, but recommended that it receive the same state-level DPH reviews as other nursing homes in the state.

“We can think of no reason or explanation why the veterans at the Soldiers’ Home should not receive the same protections as residents at private facilities,” Pearlstein wrote.

A bill proposed by Gov. Charlie Baker would require annual DPH inspections of the Chelsea and Holyoke soldiers’ homes, with more frequent inspections when necessary.

Barabani supports putting the Holyoke Soldiers’ Home under DPH auspices, an agency he said has more expertise in running a health care facility than the Department of Veterans’ Services, where no one has medical administration experience.  Barabani said having dual inspections – by the state and federal agencies – “would ensure all standards are met.”