Report: VA nursing homes score low

Van Zandt center shows mixed results in recent analysis

A recent USA Today/Boston Globe story on VA nursing homes showed that they compared unfavorably in general with private nursing homes on a variety of measures nationwide.

A spreadsheet published with the article showed that the nursing home within Van Zandt VA Medical Center in Altoona had mixed results — with quality measures worse than the average for private homes in the U.S. in six of the 11 categories.

“More than 100 VA nursing homes scored worse than private nursing homes on a majority of key quality indicators, which include rates of infection and decline in daily living skills, according to the analysis of data withheld by the VA from public view,” the USA Today/Boston Globe article stated. “More than two-thirds of Department of Veterans Affairs nursing homes last year were more likely to have (residents with) serious bedsores, as well as suffer serious pain, than their counterparts in private nursing homes.”

The Van Zandt nursing home came out worse than the average private home in the percentage of:

– Serious pain in the last five days for short-stay residents, with its percentage of 25.69 being twice as high as that for the private homes.

– Serious pain in the last five days for long-stay residents, with its percentage of 24.11 being four times as high as that for the private homes.

– Bed sores among short-stay residents, with its percentage of 4.16 being four times as high as that for the private homes.

– Serious bed sores, with its percentage of 12.73 being twice as high as that for the private homes.

– Catheters left in the bladder, with its percentage of 28.64 being 15 times as high as that for the private homes.

– Urinary tract infections begun within the past month, with its percentage of 11.2 being three times as high as that for the private homes.

Conversely, the Van Zandt nursing home came out better than the average private home in its percentage of:

– Short-stay residents receiving anti-psychotic drugs, with a percentage of 0.94, less than half that for the private homes.

– Residents who fell and were seriously hurt, with a percentage of 1.57, less than half that for the private homes.

– Residents who lost their ability to perform daily activities, with a percentage of 13.68, about 10 percent less than that for the private homes.

– Residents restrained daily, with none, compared to 0.4 percent of residents in the average private nursing home.

– Long-term residents who received anti-psychotic drugs, with a percentage of 9.57, 61 percent as high as that for the private homes.

Measures for the Van Zandt nursing home are now available for the year ending March 31, and those show improvement in six of the categories, an identical performance in one category and worsening performances for the rest, according to Van Zandt spokesman Shaun Shenk.

Most of the changes were small.

The hospital reduced the percentage of short-stay residents with bed sores; short-stay residents receiving anti-psychotic drugs; residents with catheters left in the bladder (42 percent better); long-term patients with pressure sores; long-term patients receiving anti-psychotic medications; and long-term patients with urinary tract infections.

Van Zandt did worse in the percentage of short-stay residents with serious pain in the last five days; residents who fell and were seriously injured (47 percent worse); those who lost their ability to perform daily activities; and long-term residents with serious pain in the last five days.

Van Zandt’s performance remained the same for those in restraints — there continued to be none.

The categories in which there were improvements may reflect changes instituted at Van Zandt since last fall, after the arrival of permanent Director Sigrid Andrew, according to Shenk.

Those changes center on becoming more “patient-focused,” Shenk said.

In keeping with that focus, management has been looking at the quality-measure performances and has been consulting both patients and employees who have daily interaction with them, he said.

One of the difficulties with the performance measures — they are promulgated by the federal Centers for Medicare and Medicaid Services — is that they’re new to the VA, Shenk said.

So it is taking time for VA employees to adjust, he said.

One advantage of using the measures is that they now make it possible to compare VA nursing home performance with that of private homes, he said.

One change at the facility has been to mix certified nursing assistants with registered nurses and licensed practical nurses, so the RNs and LPNs can focus on activities commensurate with their skills, according to Shenk.

“Employees want to work to the full extent of their license,” he said. And RNs would prefer not to have to change bedpans.

With the revision, Van Zandt backed away from the previous practice of keeping a “fully licensed nursing staff,” Shenk said.

Another change has been to offer chemotherapy at the hospital, eliminating the need for cancer patients to take long bus rides to the VA in Pittsburgh for treatment, while allowing family members to remain with the patients while they receive the treatments here.

Another helpful practice is welcoming help from veterans service organizations like the American Legion and the Veterans of Foreign Wars, according to Shenk.

Other innovations recently instituted include early detection and diagnosis of problems with urinary tract infections, better ways for preventing bedsores and for handling catheterizations and the telemedical delivery of wound care, according to Associate Director Derek Coughenour, who spoke to the Mirror last month.

The Van Zandt nursing home received three of five stars in its overall second-quarter rating, the hospital reported last month.

It was an improvement of one star from the previous quarter — although the home received just one star for the “quality” component of that rating.

That was offset by a five-star rating for staffing.

Mirror Staff Writer William Kibler is at 949-7038.

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