By Thomas Goldsmith

Residents of North Carolina’s state veterans nursing homes would get much more attention from the General Assembly under a state House budget proposal that could bring numerous changes to the state’s approach to publicly-funded, yet privately managed homes. 

Meanwhile, a Georgia for-profit company has again won a five-year contract to manage the four homes, where 39 residents died from COVID-19 infections last year. PruittHealth, of Norcross, Ga., earned a renewal of the contract by bidding against two competitors for the business of running the homes, according to an NC Department of Administration spokeswoman. 

The budget bill’s proposal (see p. 500) could bring changes to the nursing homes intended to  place some veterans in existing skilled nursing facilities, instead of in the four state-owned homes. In the bill’s list of actions to be taken in a study of long-term care for veterans, two stand out:

  • “Evaluate current resources by determining programmatic approaches to avoid  new construction of State veterans’ homes” 
  • “Consider alternate models of care prior to expanding veterans nursing homes.” 

In a series of stories beginning last year, North Carolina Health News detailed COVID-related deaths in the homes and the consistent lack of full accounts from Pruitt of how the COVID-related fatalities happened.

Jordan Monaghan, press secretary for Gov. Roy Cooper, responded Tuesday to questions about whether the administration favors the rethinking of state veterans nursing homes advanced in the House budget bill. 

“While a final budget has not been passed, the Governor has been clear that all issues should be on the table for discussion and that a compromise must reflect the priorities of all parties,” he said. “Ensuring the high quality of health care and long-term living facilities for our veterans is critical and the administration continues to review these provisions.”

A representative of Pruitt’s communications team responded Wednesday:

“It is an honor and a privilege to serve those who have given so much of themselves for our freedom and our country, and we are grateful to the North Carolina Department of Military and Veterans Affairs for entrusting the PruittHealth family of providers with caring for these heroes for another five years.”

Reports drive increased scrutiny

The NC Health News coverage brought attention to the situation from Cooper’s office and the General Assembly, said state Rep. Grier Martin (D-Raleigh), a veteran who served tours of duty in Afghanistan and chair of the North Carolina Military Affairs Commission

“It got the administration’s attention,” Martin said. “And it was definitely a topic of a lot of conversation among legislators.

“That brought very clear attention to the need, I think, to pay more attention to the veterans homes.”

State government in North Carolina owns veterans nursing homes in Fayetteville, Kinston, Salisbury and Black Mountain that rely on Medicare and Medicaid funding as well as private payments for residents’ stays. That means the operations have little effect on the state’s overall budget, and don’t jump out at budget planners, Martin said.

“Both parties have a tendency to say, ‘We support the troops, we love our veterans,’” he said.  “And then we don’t pay the attention we should. I think this is realization amongst everybody involved that here’s an opportunity to change direction.”

The House proposal would direct the Department of Military and Veterans Affairs to work with the Department of Health and Human Services on a $250,000 probe to weigh state veterans’ long-term care needs as part of planning for “enhancing long-term care and services for veterans.” The language of the budget provision makes clear that its authors envision offering veterans choices beyond the existing four homes. 

Detailed demands

One section of the provision asks that the staff compiling the report “incorporate the presence and location of current State Veterans Homes, and the services they provide, in a larger long-term system of care to meet the needs of veterans in both rural and urban areas.”

The assessors are also to encourage new relationships with the nursing home industry under which some could be certified for payments from the federal Department of Veterans Affairs

Planners would also be told to realize and make changes based on the reality that veterans’ needs are often complicated and deeper than an institutional mode of care can address. Also, they should recognize the situations of veterans who served in, before and after the Gulf War.

At the conclusion of the system assessment and plan, the state would hire an independent consultant in the field to report on how well it was done.

In another section, the authority to pay for scholarships for children of wartime veterans would be transferred from DMVA to the State Education Assistance Authority, with a board mostly appointed by the governor.

In August 2020, Cooper said the state would examine Pruitt’s contract for running the homes. The document was renewed for one year in November 2020, at the rate of 9.25 percent of revenue. At the time, family members of residents and long-term care experts told NC Health News that the rate was high.

Most recent Department of Health and Human Services figures show 38 current cases of COVID-19 among the homes.

The veterans’ homes in Fayetteville and Kinston most recently received five stars, the top rating from the federal Nursing Home Compare website. The Black Mountain facility received four stars and the Salisbury home got three. 

Pruitt received its five-year extension late last month. NC Health News has requested all bids submitted for the work. 

Treatment of veterans in state nursing homes eyed:

Under the proposed House budget bill, the Division of Military and Veterans Affairs would be required to file an annual report on the State Veterans Homes that would detail residents’ admissions, discharges, and deaths; their age, gender, race, and ethnicity; and information on the satisfaction level of residents and families.

The reports would go to the joint legislative oversight committee on General Government, the Senate appropriations committee on General Government and Information Technology, the House of Representatives appropriations committee on General Government, and the Fiscal Research Division.

  • Source: House appropriations proposal

NC Health News editor Rose Hoban contributed reporting to this story.

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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...