A physician and care manager address dismal nursing home rating at Canandaigua VA

CANANDAIGUA — Combat veteran Robert Van Keuren of Canandaigua wants answers. And action.

He isn’t alone. With more than 60,000 veterans living in the Finger Lakes region, many are disturbed by the one-star rating recently revealed for nursing home care at the Canandaigua VA Medical Center. The Canandaigua Living Center that provides nursing home care at the VA on Fort Hill Avenue received the lowest ranking possible, with one out of five stars as of Dec. 31, 2017. An exclusive investigation by USA Today and Boston Globe showed Canandaigua to be one of 60 out of 133 homes the VA runs nationwide to receive the lowest score.

Eleven key indicators include rates of anti-psychotic prescription, pressure ulcers, pain and residents’ deterioration.

“It’s extremely discouraging, disheartening,” said Van Keuren, a former VA employee awarded in 2011 for his military service and achievements leading the upstate VA network’s Homeless Veterans Program. “I am ashamed we have a VA that we all fought so hard for, to get this negative rating,” he said.

Van Keuren and others want to know why this happened and what the VA is doing about it.

“Would you put your grandfather in a one-star nursing home?” he asked.

At the Canandaigua VA Thursday, questions about the rating went to two VA staff directly involved. Dr. Suzanne Gillespie, associate chief of staff specializing in geriatrics and extended care rehabilitation at the VA, explained what’s behind the one-star rating. She and Judy Schwingel, geriatrics and extended care manager for Bath and Canandaigua VA, talked about VA response to the scoring and ongoing efforts at improvement.

“We are afforded a great privilege in caring for our nation’s veterans,” said Gillespie, who has worked with veterans and in geriatrics for more than a decade. “It is a complicated population, but it is a task I personally take very seriously. And it’s a task that I know our entire team and leadership of the organization takes very seriously.”

In a June 12 press release the VA announced it was “making public for the first time its annual nursing home ratings … . The data show that, overall, VA’s nursing home system — composed of more than 130 community living centers — compares closely with private sector nursing homes, even though the department on average cares for sicker patients in its nursing homes than do private facilities.”

An updated star rating for the period October 2017 through March 2018 shows Canandaigua nursing home inched up to two stars. In several categories the Canandaigua center rates below both the VA average as well as the national average for private sector nursing homes.

Those areas involve residents with new or worsened pressure ulcers and residents who newly received antipsychotic medication. Also worse than the VA or national averages was a rating for percent of residents whose physical function improved from admission to discharge.

Addressing specifics, Gillespie said Canandaigua VA emphasizes its care for veterans with mental illness. “Many carry serious combat injuries,” she said. She said many have post traumatic stress disorder and the VA overall treats much more of this and other types of mental illness than do nursing homes used by the general population. In some cases antipsychotic medication may be the best treatment, she said. Gillespie said the VA is also doing more with alternative treatments that include various therapies, exercise and other methods to help veterans with mental illness.

Gillespie and Schwingel also talked about veterans as being at greater risk for pain than in the community at large. VA nurses, social workers, pharmacists and others continue to work as a team to improve care, they said. Gillespie mentioned the use of acupuncture, chiropractic, exercise activities and other ways the Canandaigua VA is always striving to do better.

One area that has for a long time received attention is preventing falls among veterans. The Canandaigua center scored better than both the national and VA average scoring on rating falls with major injury among vets.

Gillespie and Schwingel said staffing at the Canandaigua center is of the highest quality, in terms of skill and training levels as well as numbers of those caring for veterans. So staffing is not a factor in low ratings, they said.

The Canandaigua VA Community Living Center and Nursing Home has, in all, 116 beds. At any given time it averages 90 residents. Most are long-term residents, while about 15 percent stay no more than 100 days.

According to Gillespie and Schwingel, the latest approach to the star rating for the VA seeks to make it comparative to the rating for community nursing homes. That has posed new challenges for ensuring its ratings fit criteria and accurately reflect what is going on, they said.

Schwingel said in terms of the rating, it’s a “misconception that it got so low … it was how the system was set up that you generate your first level of data.”

“It is a starting point,” Schwingel said.

Schwingel and Gillespie said score cards don’t tell the whole story. The Canandaigua VA excels in areas measured by quality of life, they said, in talking about “social engagement” and helping veterans find “meaningful, purposeful activity.” Gillespie said those caring for veterans at the VA put a lot toward care and support of both veterans and their families. The local facility is also known for its strong connection to the community, she said.

“We have been working very diligently and passionately to improve our care in whatever measure we have available to us,” she said. “We don’t want to match the average. We want to be superlative in any way we can in the way we are providing care to our veterans.”

Wayne Thompson, a Marine Corps veteran and retired VA registered nurse, is chairman of the Finger Lakes Veterans Advocacy Council. He said the council expects an update in August on the rating from Canandaigua VA Associate Director Richard Salgueiro. The Finger Lakes Veterans Advocacy Council wants to “ensure that veterans in the Finger Lakes area get the best quality care,” he said.