What veterans deserve: The patient safety crisis of VA health care

In recent years, shoddy care and administrative lapses at Veterans Health Administration hospitals have received extensive media coverage. But according to a recent Boston Globe report, another serious patient safety crisis has been playing out in VA nursing homes with virtually no public scrutiny.

The Veterans Health Administration, an arm of the U.S. Department of Veterans Affairs, is the nation’s largest integrated health-care system. According to the VA’s website, it provides care at 1,240 health-care facilities, including 170 medical centers and 1,061 outpatient facilities, but it also operates an extensive network of nursing homes. This network serves approximately 46,000 veterans per year with facilities in 46 states, the District of Columbia and Puerto Rico.

According to reporting by Andrea Estes and Donovan Slack in the Boston Globe, the VA has long tracked detailed quality measures on its long-term care facilities but has hidden them from public view, “ … depriving veterans of potentially crucial health-care information.” In 2017, 60 of the VA’s facilities — nearly half of the entire network — received the agency’s lowest grade of one star out of five stars for quality of care. The only reason we know about this is because the Globe and USA Today obtained copies of internal VA documents containing the quality-tracking data.

Nursing homes serve a uniquely vulnerable population and are highly regulated. Private nursing homes are required by federal regulations to disclose a host of information regarding the care they provide and how they provide it. Much of this data, along with inspection reports and quality grades derived from the data, is publicly available. These regulations, however, do not apply to the VA, allowing the agency to keep its patient safety dangers hidden from view.

The VA’s own quality data paint a fairly bleak picture. VA nursing homes scored lower on average than private-sector facilities on nine of 11 key quality measures in 2017, including the use of antipsychotic medication and overall deterioration of residents. Residents of VA nursing homes are also five times more likely to report being in pain than residents in private nursing homes. The lowest-ranked facilities are spread across 32 states. Pennsylvania has five one-star facilities; Texas and California have four each.

For more than 10 years, the VA has contracted with the Long Term Care Institute Inc., to inspect VA nursing homes and provide reports to the agency. Reports obtained by the Globe describe numerous instances of neglect in VA facilities, including a veteran lying in bed covered only by a urine-and-feces-stained bedsheet. A veteran at a VA facility in New England died in 2016 while the aide who was responsible for protecting his safety played video games on her computer.

A VA spokesman blamed the Obama administration for failing to make quality data public, claiming that the under the Trump administration, “… transparency and accountability have become hallmarks of VA.” As the Globe notes, however, the VA did not release any data until after both papers contacted the VA for comment regarding the documents they had obtained.

The VA’s initial response was to ask for more time to answer the reporters’ questions. Without answering any of the questions, it then just released the “star” quality ratings without any of the underlying data necessary to interpret the ratings.

Families of veterans are thus left without the information necessary to make informed choices. According to Robyn Grant, the director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, the VA has “got this whole sort of parallel world out there that’s hidden.” It is simply unacceptable, Grant said, that families looking for a veterans home are left in the dark.

All of this raises the question, why do our veterans suffer worse care than residents in the private-sector nursing home industry? The real solution is to allocate the funding and resources necessary to provide five-star care for all 46,000 residents of VA facilities. Until that happens, however, the government should at least help families avoid the worst of the lot by providing transparency.

We owe our veterans at least that much.