By Thomas Goldsmith and Riley Davis

The 36 deaths of North Carolina veterans in state veterans nursing homes have gotten the attention of Gov. Roy Cooper, whose spokesman says he’s moving to hold accountable the private management company that has run the homes for 22 years.

“The men and women who bravely served our nation deserve the best care in this pandemic,” Cooper spokesman Ford Porter said in an email July 30. “State health officials have taken extensive action to protect residents of nursing homes from COVID-19, including testing, personal protective equipment, and on-site inspections and enforcement if the homes’ infection procedures are deficient.”

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Then came an apparent stated intention to do something about it in the case of PruittHealth, the Georgia corporation that receives a commission amounting to about $4 million annually to run the homes in Fayetteville, Salisbury and Kinston, where a combined three dozen men died, as well as a fourth facility in Black Mountain.

“The administration is taking action to hold the management company accountable to provide quality care to North Carolina veterans,” Porter said.

A Pruitt spokeswoman declined to comment on the governor’s position.

Cooper’s statement, the first from a high-ranking North Carolina official on the veterans homes, came as the latest development in local and national efforts to investigate the operation of state-owned nursing homes for veterans. On Wednesday, a subcommittee of the U.S. House Committee on Veterans’ Affairs heard a plain message from federal watchdogs to the VA:

“VA Needs to Continue to Strengthen Its Oversight of Quality of State Veterans Homes.”

The testimony and report from the Government Accountability Office were the latest to draw attention to problems with state veterans nursing homes among a growing list of state representatives, U.S. senators and representatives, governors of several states, state legislatures and ad hoc task forces.

On Wednesday the GAO criticized the VA’s failure to present information about the quality of care at state veterans nursing homes on the VA’s website. This contradicted VA’s position that they had no oversight over the state homes even though the agency contributes significant pieces of their funding.

“VA is the only federal agency that conducts regular oversight inspection on the quality of care of all [state veterans homes] and, as a result, is the only agency that could share such quality information on its Website,” Sharon M. Silas, GAO director of health care, said in prepared testimony to Congress.

Nationwide attention to local problems

These are the most recent developments, but far from the only ones, in the examination of the quality of care at the state veterans homes, of which there are more than 130 across the country.

On July 22, the Centers for Medicare and Medicaid Services under the direction of President Donald Trump said it would spend $5 billion on improving testing and other practices at all the nation’s nursing homes, in part to build better models of infection control.

Earlier in July, the North Carolina Department of Health and Human Services cited the State Veterans Nursing Home in Salisbury, managed by the for-profit PruittHealth Services, for lacking a plan for preventing infection at the facility.

In the wake of a catastrophic COVID-19 outbreak at the Soldiers Home in Holyoke, Mass., Gov. Charlie Baker launched an in-depth investigation that resulted in a scathing 174-page report faulting administrators of the center.

In June, North Carolina DHHS inspectors found that the state veterans nursing home in Salisbury, managed by PruittHealth was allowing as many as four or five carloads of visitors each weekday, despite bans of such visits under state and federal guidelines.

More of the nation’s veterans are completing their lives in nursing homes as they age and in some cases deal with intractable ailments caused by their service. The movement on enforcement comes as the nation’s system of state-owned veterans nursing homes deals with an investigation into their practices launched by two U.S. senators.

For-profit long-term-care chains can put concern for profit above residents’ safety, said Suzanne Gordon, a University of California-San Francisco School of Nursing professor and a long-term care authority.

“You can have falls, bedsores, you name it, infection — so it’s the perfect storm when you have a pandemic like COVID-19,” Gordon said. “You have poor staffing, you have poor pay so that nursing home workers have to work in multiple different facilities. And they take the infection from one facility to another. You have an incredibly vulnerable population. And you have low staffing and low training.”

Nationally, hundreds of COVID-19 deaths in state veterans nursing homes have created pushback from elected officials, family members and others who at least want more information about what’s going on.

The NC State Veterans Nursing Home in Fayetteville is managed for a percentage of revenues by PruittHealth, a Georgia-based corporation. State records show that 20 veterans died of COVID-19 here during the pandemic. Photo credit: Greg Barnes

A good bit of buck-passing surfaces along with issues of these nursing homes. After all, they are owned by the state, which can manage the facilities as well, but has chosen to employ PruittHealth care for 22 years under a contract that now pays the company 9.25 percent of overall revenue.

The bills and Pruitt’s commission are paid with a combination of federal Medicare, Medicaid and Veterans Affairs payments, as well as some private payments.

‘VA pays for veterans to receive care’

After more than 70 veterans died in a Massachusetts soldiers home, Sens. Elizabeth Warren and Edward Markey, Democrats from that state, placed the federal Department of Veterans Affairs at the heart of possible reform of SVHs, or state veterans homes. The Soldiers Home in Holyoke, Mass., contained nursing home beds, a dormitory section and hospice care.

“While VA does not supervise or control the administration of State Veterans Homes, VA pays for veterans to receive care at these facilities and is the only entity that inspects every SVH in the nation,” they wrote on May 5.

“As long as VA is utilizing State Veterans Homes to provide care for veterans and pays for all or some of care costs in SVHs across the country, the Department should faithfully and efficiently implement GAO’s recommendations and ensure veterans are receiving quality care.”

Veterans Affairs guidelines certify who is eligible for a bed in these homes, and the agency conducts yearly inspections of the facilities. VA communications staff told NC Health News in a series of emails that the agency does not run these facilities, and that it is up to individual states to decide how they will operate their veterans homes, and whether to contract with private companies.

However, a 2019 Government Accountability Office report found that the VA can cut the purse strings for a state veterans nursing home if the center doesn’t measure up.

“… federal law prohibits payments to SVHs that do not meet standards the VA prescribes and authorizes VA to inspect any SVH at such times as VA deems necessary to ensure that such facility meets those standards,” the auditors said.

In addition to state-owned nursing homes of the sort managed by Pruitt, veterans can choose among community living centers that are owned and operated by the VA and community nursing homes that operate under a VA contract.

‘I’ll continue pressing’

U.S Rep. David Price (D-NC), North Carolina’s only member on the House Appropriations Committee, said he’ll make use of his position to push for the best care for veterans in state nursing homes.

“I’ll continue pressing the Department of Veterans Affairs and Department of Health and Human Services to provide additional resources to these vulnerable residents to ensure a safe environment for all,” Price said in a statement to NCHN.

As a national examination gets underway of nursing home practices regarding COVID-19, PruittHealth CEO Neil Pruitt Jr. has been called on to become part of it. On June 19, Pruitt became one of 25 professionals with long-term care expertise named to the Coronavirus Commission on Safety and Quality in Nursing Homes.

The federal Centers for Medicare and Medicaid Services announced the appointments and said that the panel would conduct “an independent review and comprehensive assessment of the nursing home response to the Coronavirus Disease.” The statement says members will be working under Trump’s leadership.

In May, the North Carolina General Assembly, as part of one of two COVID-19 relief bills, asked the North Carolina Area Health Education Center, or NC AHEC, to include nursing homes in a study of the effects of the pandemic and preparation for public health crises to come.

Anna Amirkhanyan, the American University professor whose studies include public-private relationships in nursing homes, noted that community voices are largely lacking when public resources are privatized.

“We have not observed any major trends in citizens setting the agenda or resolving and participating in larger policy issues like privatization of a major chronic care provider in the community,” she said.

Professor: Society fails to value long-term care

The decision to contract a state’s nursing home operations out to a private company isn’t out of the ordinary, Boucher said.

“The state could certainly see that as a cost-cutting measure, and a human resources efficiency measure,” he said.

Leland resident Jennifer Brigman remains concerned about the way her dad, retired Master Sergeant Harold Lee Brigman, Sr., was treated at the Fayetteville center, and the way that dollars for his care got spent by PruittHealth.

Retired Master Sergeant Harold Lee Brigman, Sr., 85, seen here with daughter Jennifer Brigman, of Leland, died of COVID-19 in May in the NC State Veterans Home in Fayetteville, where 19 of his fellow residents also died after contracting the disease. Harold Brigman served for years as a police detective following his military service. Photo courtesy: Jennifer Brigman

Harold Brigman 85, died May 23 after living in the Fayetteville state veterans nursing home since 2017.

“They were getting money from the Veterans Administration, they were getting money for my dad’s Medicaid, they were getting money from, from, what is it called? Tricare,” she said. “My mother was paying $2,000 a month. Out of pocket, she spent about $80,000 while my dad was there.

“Yeah, and all they did was feed him, change him, and leave him in that wheelchair.”

The pandemic has thrown dysfunctions and societal shortcomings affecting the long-term healthcare system into sharp relief, both in veterans homes and beyond, Boucher said.

“It became that way because, years ago, nobody really wanted to take control over this,” Boucher said. “It wasn’t a huge moneymaker, it wasn’t really valued by society, and still isn’t. Older folks, people with disabilities, ageism, there’s a lot of stuff getting in the way.”

Riley Davis provided assistance via the the NC News Intern Corps, a program of the NC Local News Workshop, funded by the North Carolina Local News Lab Fund and housed at Elon University’s School of Communications.

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...