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veterans health

A skilled nursing facility sign is in the foreground and a building is in the background. The facility, A PruittHealth skilled-nursing facility for veterans in Orange County, is dealing with an outbreak of COVID-19, and has a history of poor staffing.

NC commission votes to extend deal for private management of state’s veterans nursing homes

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NC commission votes to extend deal for private management of state’s veterans nursing homes - North Carolina Health News

The Georgia-based company that oversees NC’s state veterans nursing homes got approval Tuesday for a one-year contract renewal from the state Veterans Affairs Commission.

By Thomas Goldsmith

For the first time, a significant public body had a discussion of North Carolina’s deal with the company that runs the NC State Veterans Homes, at which 38 residents contracted COVID-19 and died. In all, 87 veterans were diagnosed as having contracted the virus.

A Tuesday vote by the state’s NC Veterans Affairs Commission to extend the contract of the Georgia-based PruittHealth company means the company will continue to manage the four homes without contract review or a competitive bidding process for another year. Those will come during a full contract review next year, officials said.

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Commission members meeting virtually heard an extensive presentation urging approval for contract renewal by Terry Westbrook, deputy director of the Veterans Division of the state Department of Military and Veterans Affairs.

“Within the Department of Veterans Affairs, our evaluation is that Pruitt Healthcare has continually provided the level of service and quality here that we require for our veterans, and we want to continue,” Westbrook said.

NC outlines plans in wake of 36 COVID-related veterans deaths in state nursing homes

Cooper, national leaders respond to ravaged veterans nursing homes, look ahead for solutions

Coronavirus deaths bring attention to privatized state veterans homes

Thirty-six veterans die of COVID-19 in NC state veterans nursing homes that a private company has run for 22 years

As other states take action, NC punts review of nursing homes where dozens of vets died of COVID-19

“That quality of care meets all the standards of care that the [U.S.] Department Health and Human Services has dictated.”

Commissioners had no direct discussion of how and why the COVID-19 infections and deaths happened. Nor was there mention of the 10 cases of the disease that the state Department of Health and Human Services list as ongoing at the Pruitt-run veterans nursing homes in Salisbury and Fayetteville.

In an email exchange in the two days after the commission meeting, Westbrook wrote, “There is no indication that Pruitt did anything that caused veteran deaths.”

At Tuesday’s commission meeting, Westbrook’s pitch was so positive that commission member Patrick Smathers asked if he had any criticism of Pruitt.

“I guess I’m really asking about as far as evaluating Pruitt, what would you say?” Smathers said. “Where would they need to improve on it?”

Westbrook hesitated briefly.

“If they don’t have anything, just say it,” Smathers said.

Westbrook said he hated to make the case that the corporation had nothing to improve.

“Everybody can always find things within the organization and improve them,” he said. “I think Pruitt would tell you things that they would like to do a little bit better with their personnel and they’d like to be a little better with their responsiveness and response times.”

However, Westbrook said, PruittHealth doesn’t need to make changes.

“I can tell you that I’m not aware of anything we would ask them to do differently now that would be in the best interest of how we provide service,” he said.

In a follow-up email, Westbrook said that the state will be reviewing veterans nursing home procedures into 2021, with results to be considered during next year’s request for proposals.

“In order to ensure a comprehensive RFP process and that the state has the right vendor, DMVA has renewed the Pruitt contract for one year,” he wrote. “State officials will continue to monitor and enforce state and federal regulations in the veterans homes.”

The extension of the company’s $45-million-plus contract means it will oversee the in-progress state-owned veterans nursing home in Kernersville and one planned for Raleigh, as well as those operating in Kinston, Black Mountain, Salisbury and Fayetteville.

During the commission meeting, Westbrook said that although 38 residents had died with COVID-19 diagnoses, only 13 had had the disease listed as the principal cause of death on death certificates. Others had COVID along with heart disease, cancer and other conditions that pose mortality risk factors for older people and others who contract the coronavirus.

Commission chair Jane E. Campbell then noted that the standard used across government departments relies on counting deaths in which the person was positive for COVID-19, so that the Veterans Affairs Commission should rely on the higher figure.

Commissioners approved the extension by acclamation after hearing that election-year timing caused the discussion of the deal to be delayed.

“When it came time to our last meeting, we did not feel that undertaking the discussion of the renewal of this was something that we wanted to take on at the end of September of an election year,” Campbell said. “And so we specifically talked about scheduling a meeting to have this conversation post Nov. 3.”

On Thursday, Westbrook responded, “There are no political considerations used in DMVA decisions on contract actions and veteran care and there was no delay.”

Campbell answered questions via a Thursday night email.

“My comments were an attempt to clarify that I did not even want the perception that the decision had any political/partisan connections,” she wrote. “This was a vote to make the right decision about providing care for our fellow veterans who are residents at the 4 state veterans homes. However, perceptions can be reality. For that reason when the timing of this meeting was discussed – it made sense to me to wait until after Nov. 3. “

The contract with Pruitt will ultimately be awarded by the Department of Administration’s fiscal management division.

What has Pruitt done to improve the state veterans nursing homes?

Terry Westbrook, deputy director of the Veterans Division of the state Department of Military and Veterans Affairs, told NC Health News that PruittHealth has brought improvements to the veterans nursing homes such as:

  • “A system that provides an additional air filtering system through infrared light to clean over 99% of possible contaminants from the air supply,
  • “A system that can automatically check a person’s temperature when they first enter the building and determine if any additional screening practices need to be executed, and
  • “Increasing the COVID-19 testing through Point of Care testing to continually evaluate the status of residents and staff.”
shows a county map of north carolina with darker counties being places with higher rates of COVID-19. The darkest counties right now are all rural.

Coronavirus Today – Oct. 21 – Paused in Phase 3; Counties asked to toughen COVID restrictions; Promising treatment underperforms; Veterans’ home outbreaks

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Coronavirus Today – Oct. 21 – Paused in Phase 3; Counties asked to toughen COVID restrictions; Promising treatment underperforms; Veterans’ home outbreaks - North Carolina Health News

Thirty-six NC counties with high COVID-19 transmission asked to consider restriction measures beyond state requirements.

By Anne Blythe, Hannah Critchfield and Thomas Goldsmith

On a day that North Carolina’s COVID-19 death toll topped the 4,000 mark and the number of people hospitalized with illness related to the novel coronavirus is the second highest in the pandemic, Gov. Roy Cooper hit the pause on any further reopening.

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North Carolina public health officials reported that 4,032 people have died from illness related to COVID-19 and that 1,219 people are in the hospital because of the virus.

The number of cases in this state also passed the quarter-million mark with 250,592 lab-confirmed cases of the virus leading to even more cases of pandemic fatigue.

“As this pandemic continues, I know that it’s tiring and difficult to keep up our guard, especially when we’re gathered with people we love,” Cooper said Wednesday during a briefing with reporters. “But it’s necessary. No one wants to spread COVID-19 accidentally to friends or family. So we must keep prevention at the forefront. Wearing a mask shows that you care about people. It’s more for them than for you. Wearing a mask is an easy way to protect our communities and to look out for each other. Confronting the virus head on and doing our part as individuals is good for our health and it’s good for our economy.”

Despite the pleas throughout the pandemic for mask use, some in North Carolina continue to ignore them, frustrating those who embrace the idea as a necessary measure to slow the spread of COVID-19 and live with the virus more safely as the pandemic continues.

 

Seeking help from high-transmission counties 

On Tuesday, in an effort to reverse disease trends that have been getting worse, the state Department of Health and Human Services and the state Department of Public Safety sent a letter to county managers and chairs of their elected boards asking for help in counties that have:

  • Had 300 or more new cases over the past 14 days;
  • Been identified by the White House COVID-19 Task Force as a county of concern;
  • A rate of cases that is greater than 50 per 10,000 people; or
  • One of the three most populous in the state.

Letters went to Alamance, Avery, Burke, Caldwell, Caswell, Catawba, Chowan, Cleveland, Craven, Cumberland, Davidson, Duplin, Edgecombe, Gaston, Graham, Greene, Guilford, Hoke, Hyde, Johnston, Lincoln, Mecklenburg, Moore, Nash, New Hanover, Onslow, Pitt, Randolph, Robeson, Rockingham, Rowan, Scotland, Union, Wake, Watauga and Wayne counties.

Mandy Cohen, the DHHS secretary, discussed this possible approach a week ago during a briefing with reporters in which she was asked about New York Gov. Andrew Cuomo’s decision to close down schools, restaurants, synagogues and churches in some New York City neighborhoods where COVID-19 cases were on a rapid rise.

The letter suggests that some counties might want to adopt ordinances of their own that are stricter than the statewide thresholds set in Cooper’s executive orders.

Under those orders, criminal citations may be issued to people not following the rules. County ordinances can impose civil penalties, such as fines that won’t result in criminal records, for people who blatantly violate measures intended to protect the public’s health.

Early in the pandemic, some counties and cities set curfews and ordered face coverings in public before statewide measures were in place.

Cooper and Cohen have suggested such actions to help tamp down hotspots where health care systems are beginning to feel strained.

Dan Forest, the Republican lieutenant governor running against Cooper, a Democrat seeking re-election, quickly criticized the request to the 36 counties in a post to Twitter.

The memo in the tweet begins: “Is Gov. Cooper Trying to Continue His Shutdown of NC by Passing the Buck on His Responsibility?”

“To put it bluntly: Governor Cooper is attempting to use local governments to punish individuals doing what they can to survive,” the memo states. “He has repeatedly said he has full authority over his COVID shutdown, which means he also gets 100 percent of the responsibility. Passing the buck to local businesses and municipalities is the antithesis of leadership.”

Forest, who has held rallies indoors and outdoors with attendees not wearing masks or social distancing, has said he would rescind the mask order if elected.

Cooper was asked about Forest’s response during the briefing with reporters.

“What we’re doing now in working with local governments to slow the spread of the virus is no different from how we started this thing back in March and April and June,” Cooper said. “We set a floor with statewide restrictions, but at that time we also encouraged local governments, that if they were seeing more viral spread in their community, and it worked better in their community, they could use restrictions that were greater than the state floor. And a number of our cities across the state did that and it helped us to slow the spread of the virus.”

Who will enforce the orders?

There have been times during the pandemic that local law enforcement officers in some counties have refused to or been reluctant to enforce the restrictions in Cooper’s statewide executive orders.

In June, the sheriff in Alamance County, one of the counties that received this week’s letter, refused to enforce Phase 2 restrictions when ACE Speedway held events with crowds larger than what was allowed under the statewide order.

The Halifax County sheriff said in June that his deputies would not enforce the face mask order, but reversed course this month, WRAL’s Lena Tillett recently reported, after six deputies in the department fell ill with COVID.

“A lot has happened since June,” Halifax Sheriff Wes Tripp told WRAL. “It is not a hoax.”

“More and more law enforcement across the state are beginning to recognize that it is important for them to play a role in enforcement, even if it is an informal one going and talking to people and being leaders in the community,” Cooper said, citing Tripp’s change of direction.

Health departments have enforcement power, too

Additionally, local health departments and DHHS have authority under public health laws to enforce safety precautions and make sure the state is “sending the signal that is serious and that we have to slow the spread of the virus,” Cooper said.

“I’m feeling more confident that we can enforce what we have to be able to drive down our numbers,” Cooper said. “It really takes people working together, but I think more people are recognizing that it’s important for us to do that.”

Cooper’s order puts much of the onus on retail establishments to make sure people in the restaurants, grocery stores or other shops are following the mask requirements and other social distancing measures put forth.

“Our health departments and our department of Health and Human Services also have the authority under the abatement provisions. … That already has been used in some circumstances and we anticipate that is going to be used more in the coming days, particularly working with local health department,” Cooper said.

The state health department used that process in June to halt ACE Speedway gathering held in defiance of statewide orders.

In her metrics and trends presentation on Wednesday, Cohen noted a bit of good news in that the number of people showing up in emergency departments over the past week with COVID-19 symptoms had started to decline.

But the number of cases is much higher than she or the governor would like to see and the rate of people showing up for COVID-19 tests and testing positive has crept up beyond the 5-percent mark.

Contact tracing is not working as well as Cohen would like to see either. Some people do not pick up their phones. Others are not forthcoming with information about who they have been around when reached by a tracer.

With a united front, this, too, shall pass

“This has been a really hard year. I understand how much everyone wants to be with family and friends without having to worry about a virus,” Cohen said. “We miss the people we love and the places that bring us joy or provide comfort. I haven’t seen my parents in person and I miss seeing them play with my girls. And I’m sad that I’ve never met my new baby niece.”

Over the past two weeks, public health officials have seen an increase in COVID-19 clusters in social gatherings, events such as informal get-togethers, family gatherings and parties.

Additionally there have been more cases in clusters from religious gatherings. The state recently posted new guidance for private social gatherings that includes mask wearing when with anybody not from your own household and setting up tables and chairs outside well distanced.

“Look, we’re doing everything we can to slow the spread of this virus,” Cohen continued. “The simple fact is we can’t do it on our own. Ignoring the virus does not make it go away, just the opposite.”

Cohen assured people that there will be a day when the virus is not at the forefront, but there is much work to be done in the months ahead.

“As hard as this is, it will end,” Cohen said. “We will get through this. Let’s do it by looking out for one another.”

Studies cast doubts over once-hailed COVID-19 treatment

Three new studies of a previously promising therapy for patients with COVID-19 have once again complicated the coronavirus treatment narrative.

Tocilizumab, an antibody drug commonly used to treat inflammatory arthritis, was hailed as a possible treatment for COVID-19 pneumonia early on in the pandemic. Observational studies, first in China and then elsewhere, initially suggested the immunosuppressive drug could alleviate the hyperinflammation that often accompanies severe illness from the virus, leading to a “mortality benefit” — a difference in death between treated and untreated patients.

“As a result of those studies, tocilizumab use became fairly widespread in the United States and other sites,” said Jonathan Parr, a professor of infectious diseases at the University of North Carolina School of Medicine and author of a JAMA article on the impact of the new studies. “We at UNC initially used tocilizumab for a small number of patients, but then significantly scaled back our use when we realized that we weren’t seeing the same types of clinical courses that had been described in the original study.”

Those early observations were limited to a small number of patients; guidelines from organizations such as the National Institutes of Health now recommend against prescribing tocilizumab except in clinical trials.

Three articles on more comprehensive studies, all released yesterday, present mixed results about the drug.

One, a large observational study of tocilizumab in COVID-19 involving about 4,000 people, found that individuals treated with the drug were less likely to die than those who were not (a mortality rate of 28 percent vs. 37 percent).

But the other two, which were randomized studies — considered the gold standard for trials assessing the efficacy of a treatment — found no difference in mortality between COVID-19 patients treated with the drug and those that were not.

“Whenever we are forced to make hard decisions about whether to use an off-label treatment, or an unproven treatment, we always need to give priority to the randomized trial results,” said Parr.

Based on the available evidence, Parr said he doesn’t plan to use tocilizumab for COVID-19 pneumonia in his clinical practice.

“Unless new results come out from randomized trials that tell a different story,” he said. “Which is possible.”

More studies of the impact of the drug in treating COVID-19 infection are slated to be released in the coming weeks and months.

“But until we have those results, it’s difficult to say,” Parr added. “For me personally, it’s hard to justify the use of an expensive, unproven treatment option when the randomized trial data that we have now doesn’t support its use.” – Hannah Critchfield

Two new COVID outbreaks in privately managed state veterans nursing homes

North Carolina health officials are reporting nine new cases of COVID-19 in the state veterans nursing homes privately managed by Georgia-based PruittHealth.

The N.C. State Veterans Home in Salisbury, where 15 residents died of the disease earlier this year, has five new cases, according to DHHS. The State Veterans Home in Kinston, with one previous veteran’s COVID-related death in 2020, has four new cases. Both are classified under a definition that defines an outbreak as being two or more cases.

As previously reported in NC Health News, in the four Pruitt-run veterans nursing homes in the state, 36 residents have died during the pandemic. Attempts to reach Pruitt officials for comment Wednesday were unsuccessful.

PruittHealth officials have said they will request an annual renewal this year of their long-term contract to manage the four NC state veterans nursing homes for a 9.25 percent commission. A renewed contract would also put the company in charge of two additional veterans nursing homes in the planning stages.

Gov. Roy Cooper’s administration has said it will reexamine the contract before a planned Dec. 1 contract renewal.  – Thomas Goldsmith

Coronavirus by the numbers

According to NCDHHS data, as of Wednesday afternoon:

  • 4,032 people total in North Carolina have died of coronavirus.
  • 250,592 have been diagnosed with the disease. Of those, 1,219 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
  • 218,541 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious. Nor does it reflect the number of so-called “long-haul” survivors of COVID who continue to feel the effects of the disease beyond the defined “recovery” period.
  • To date, 3,668,243 tests have been completed in North Carolina. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
  • People ages 25-49 make up the largest group of cases (40 percent). While 13 percent of the positive diagnoses were in people ages 65 and older, seniors make up 81 percent of coronavirus deaths in the state.
  • 352 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • There are 3,442 ventilators in hospitals across the state and 927 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Tuesday, 308 suspected COVID-19 cases were in intensive care units across the state.
A skilled nursing facility sign is in the foreground and a building is in the background. The facility, A PruittHealth skilled-nursing facility for veterans in Orange County, is dealing with an outbreak of COVID-19, and has a history of poor staffing.

NC outlines plans in wake of 36 COVID-related veterans deaths in state nursing homes

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NC outlines plans in wake of 36 COVID-related veterans deaths in state nursing homes - North Carolina Health News

NC Gov. Roy Cooper says he’ll have his people check out the contract that a Georgia health care company has held for 22 years with the state.

By Thomas Goldsmith 

Gov. Roy Cooper’s administration says it will review the contract management of North Carolina’s four state-owned veterans nursing homes by a private Georgia-based health care conglomerate. Because 36 veterans died of COVID-19 in the homes, Cooper wants to know what’s what before the state grants a second one-year extension of Pruitt’s five-year deal in December.

A statement from Cooper chief spokesman Ford Porter outlined some steps that the state government will take following the COVID-related deaths of 36 veterans in three of the homes — in Fayetteville, where 20 men died; in Salisbury, where 15 died; and in Kinston, where one died.

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The N.C. state-owned skilled nursing facilities have operated under the management of Norcross, Ga.-based PruittHealth since 1998 under a contract that most recently pays the company 9.25 percent of the total operating budget of the homes.

“State regulators will continue to work to ensure that Pruitt Health-managed veterans homes comply with applicable infection control regulations and CDC guidance,” Porter said in an email. “The administration is also reviewing this contract to determine if Pruitt is compliant or if any action should be taken.”

Management pact up for renewal in December

The agreement, which brings more than $4 million in annual commissions to PruittHealth, was most recently renewed by the state on January 25. The one-year extension of the five-year, $200 million contract was achieved with a one-page document that simply said the company would continue to manage the homes for some of North Carolina’s most vulnerable veterans for another year, with no changes in provisions.

Renewal Agreement – PruittHealth Veterans Services – NC Inc_

Private managers mum on deaths

A PruittHealth spokeswoman said Tuesday that the company would decline comment. The non-public company has expressed sorrow about the North Carolina veterans’ deaths with COVID but has declined any discussion of how those deaths happened, or whether the company’s performance as managers might have played a role.

Any discussion of the privatization of nursing-home management is taking place amid concentrated work nationally, as well as in North Carolina, to improve the situation of residents of these centers. Because of age, congregate lifestyle and perilous medical conditions, nursing home residents have taken a far disproportionately lethal hit from the novel coronavirus, particularly in its first months.

Several COVID-related actions taken at North Carolina’s four state veterans’ nursing homes — the fourth is in Black Mountain — have also been used at each of the 427 nursing homes across the state, state DHHS officials said.

As part of an “aggressive,” coordinated plan, each nursing home went through a focused COVID-related inspection during the summer to make sure it met infection control guidelines and goals set by the federal Centers for Medicare and Medicaid Services. Under an initiative announced Aug. 7, every nursing-home staff member will also undergo COVID-19 testing every two weeks.

DHHS ramps up testing

“We are using federal CARES dollars that were allocated to the Department of Health and Human Services for testing,” Mandy Cohen, secretary of the department, said after an Aug. 7 press briefing.

“It will be on the nursing homes … they are going to be the ones that will have to get in contact with a testing vendor or figure out whether or not they want to do the testing themselves. We will provide the funding for that.”

State Rep. Grier Martin (D-Wake), a veteran and member of the NC House Homeland Security, Military, and Veterans Affairs Committee, said that the panel was unlikely to meet before a new session of the General Assembly meets in January. Another possible source of oversight, he said, could be the NC Joint Legislative Oversight Committee on Health and Human Services. Rep. Josh Dobson (R-Nebo), one of that body’s chairs, did not return a call for comment.

“I first want to see what steps the executive branch takes and I know the Cooper administration is taking a close look at the deaths and how they should factor in going forward in any renewal of the contract with PruittHealth,” Martin said.

The unfolding of an overwhelming new virus means that methods of prevention and causes of death from COVID-19 can be complex to untangle. But it’s worth noting that many nursing homes have escaped an appearance by the infection in their facilities, including about 275 in North Carolina.

CalVets nursing homes kept COVID-19 at bay

In an example recently pointed out by Politico, the six state-run veterans nursing homes in California experienced two deaths among 875 occupied beds based on the most recent count by the Centers for Medicare and Medicaid Services.

“If you let your guard down, you are in trouble with this virus,” Thomas Bucci, the California Department of Veterans Affairs long-term-care director, told Politico. “We are only as good as our weakest employee who decides they are not going to wear a mask and just gave a resident a bath and breathed all over him.”

The 36 North Carolina men who died, at least one of whom had survived the Pearl Harbor attack, lived in nursing homes to which several merited special acceptance because of their hazardous duty exposed to toxic materials in the Vietnam and Gulf wars.

There’s a fifth state veterans nursing home managed by PruittHealth, the Georgia War Veterans Nursing Home in Milledgeville. On July 31, the Georgia Department of Public Health reported that 15 men had died in the home of COVID-related causes.

Deaths continued at privately managed Georgia center

By Aug. 11, the same health officials revised totals to say that 17 men had died in the Milledgeville center.

The numbers indicated that two veterans had died in 12 recent days in this home for soldiers, the same number who died during the entire pandemic in California’s six state-run nursing homes.

The N.C. Pruitt contract comes up for renewal by the state Department of Administration on Dec. 1. If the company retains the business, as it has for 22 years, it will also take over management duties for two new state veterans homes in planning stages for Raleigh and Kernersville.

shows rows of headstones in a veterans cemetery

Cooper, national leaders respond to ravaged veterans nursing homes, look ahead for solutions

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Cooper, national leaders respond to ravaged veterans nursing homes, look ahead for solutions - North Carolina Health News

Gaps in state federal oversight and accountability for privately run veterans homes are now facing scrutiny at all levels of government.

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.

Read the other parts of this series: Thirty-six veterans die of COVID-19 in NC state veterans nursing homes that a private company has run for 22 years
Coronavirus deaths bring attention to privatized state veterans homes

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.

shows the front of a building with several flags on poles, the American flag is at half staff, as there are dead COVID patients within. A sign in front of the building reads, "Heroes work here"

Coronavirus deaths bring attention to privatized state veterans homes

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Coronavirus deaths bring attention to privatized state veterans homes - North Carolina Health News

As COVID-19 outbreaks moved through North Carolina this year, nursing home residents quickly numbered high among those who became infected. Among that population, 36 North Carolina residents of military service died of the novel coronavirus in state-owned veterans nursing homes managed by a Georgia conglomerate, PruittHealth.

By Thomas Goldsmith and Riley Davis

With the federal government footing much of the operations bill, state veterans homes have existed since the Civil War, first to care for homeless survivors of war and those with disabilities. A second wave of soldier’s homes came after World War I.

“Prior to World War I, programs for veterans centered on pensions and ‘soldiers homes,’ where the aged and disabled could live,” historian Bernard D. Rostker wrote in a 2013 Rand Corporation research report. “After World War I, rehabilitation became an important third element of veteran care.”

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The focus of the state-owned nursing homes has changed as the nature of wars has transformed. Preference for spots in North Carolina’s homes generally goes to veterans with service-related disabilities, such as exposure to Agent Orange in Vietnam, exposure to radiation at Nagasaki and Hiroshima, or conditions related to their Gulf War environmental exposure.

North Carolina’s COVID-19 outbreaks brought the state’s first virus-linked death on March 24, to a Cabarrus County man, and soon started taking an exceptional toll in long-term care facilities.

Of 1,903 COVID-related deaths in the state by July 30, at least 797 have been of people who lived in nursing homes. According to state and corporate records, 36 of North Carolina’s military veterans have died from COVD-19 in nursing homes that are owned by the state, but for more than two decades have been under the contract management of a privately owned health care conglomerate.

State records show that the state of North Carolina agreed in 2014 to pay Georgia-based PruittHealth an estimated $207 million in the past five years to run the state’s veterans nursing homes. The company had received many millions more in commissions during the preceding 17 years.

If the current contract wins a second extension in December, Pruitt will take over the management of two new state veterans nursing homes, already announced for Raleigh and Kernersville.

Dr. Philip Sloane, a geriatrician and distinguished professor of family medicine at UNC  Chapel Hill, speaking generally, said COVID-19 overwhelmed nursing homes and other health care facilities because it was indeed novel and came on so fast.

“When COVID gets into a facility, it gets into it,” he said. “And that’s the problem, especially early on when we just knew nothing and nursing homes were so ignored by all the responses to COVID.”

Related story: Read the other parts of this series: Thirty-six veterans die of COVID-19 in NC state veterans nursing homes that a private company has run for 22 years

Cooper, national leaders respond to ravaged veterans nursing homes, look ahead for solutions

Public health officials concentrated on getting ventilators and other hardware, but didn’t initially focus on making sure that nursing homes had personal protective equipment or PPE, Sloane said.

“Nobody said that and then they were stuck,” he said.”Then when you got somebody that you think had COVID, if they had to get the health department to do the test, the test would come back in five days, or six days. We really flubbed it for months, as a society.”

Show me the money

North Carolina’s Veterans Nursing Homes have been managed for 22 years by the Georgia-based PruittHealth company, which takes a commission exceeding $3.5 million annually from the stream of Veteran Administration, Medicare, Medicaid and other funding designated to operate the state veterans nursing homes.

The amount of Pruitt’s commission has importance because for-profit, long-term-care ownership and management chains have the potential to put concern for profit above residents’ safety, said Suzanne Gordon, an assistant adjunct professor at the University of California-San Francisco School of Nursing and a widely published authority on long-term care.

“It’s the perfect storm when you have a pandemic like COVID-19,” she said in a phone interview. “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.

“You have low staffing and low training.”

Pruitt privatizes management

PruittHealth, founded in 1969, first managed a facility of this type in 1996, when the company won a contract to run the Georgia War Veterans Home in Milledgeville. A story in the Atlanta Constitution describing the deal noted that the Georgia State Employees Union sued Pruitt in an unsuccessful move to halt the takeover. The newspaper also cited past problems with Pruitt’s supervision of other Georgia nursing homes during the 1990s.

By 1998 Pruitt had successfully bid for management of the North Carolina homes. Since then, the company has retained the contract for five terms in a process that garnered little media or public attention. The company manages the four North Carolina state veterans nursing homes — comprising 100 beds in Black Mountain,150 beds in Fayetteville, a 100-bed center in Kinston, and 99 beds in Salisbury.

shows people in military uniforms talking to an aging veteran who's in a wheelchair, they're all smiling and laughing.
Before the days of COVID-19, local service groups would frequently visit the veterans homes. In this photo from Dec. 2016, Chief Master Sgt. Shane Wagner (left), 4th Fighter Wing command chief, and Col. Christopher Sage (center), 4th FW commander, laugh with Eugene Shaw, U.S. Army veteran and resident of the State Veterans Home in Kinston. More than 45 volunteers visited with over 90 veterans and passed out goody bags and holidays cards. Photo credit: U.S. Air Force/ Airman Shawna L. Keyes

The only bidder beside Pruitt for the most recent North Carolina contract was the for-profit, Minnesota-based Health Dimensions Group, which failed to complete the second portion of a two-bid process. The company manages a Wisconsin state veterans home in Chippewa Falls, which has had no COVID-19 cases, according to a CMS database.

The Health Dimensions 2014 bid for the work provided by the North Carolina Department of Military and Veterans Affairs lacks a crucial detail — the percentage of revenue that the company would receive to oversee the homes. Health Dimensions officials did not respond to a request for additional information.

Today, PruittHealth manages the state veterans nursing homes under a one-year extension of the 2015 document it signed in 2015. Anna Amirkhanyan, an American University professor who studies long-term care, was an author of a paper that compared public, nonprofit and for-profit nursing home care.

“Consistent with … the ample empirical research on nursing home quality, we found that for-profit nursing homes have significantly lower care quality compared to public and nonprofit nursing homes,” Amirkhanyan and colleagues wrote in 2018 in the academic Journal of Public Administration Research And Theory.

PruittHealth company has championed openness about its COVID-19 caseloads and announced that a resident of one of its Georgia nursing homes was presumed to have the disease on March 19.

On April 1, the company announced an Alert Code Red, or high-level warning, for its PruittHealth-owned and -operated Carolina Point nursing home in Chapel Hill, managed and owned by the company, but not a veterans center.

An Alert Code Red means only essential staff will come to work and that no new admission will be allowed. In addition, specific, higher levels of infection control including more frequent cleaning and “postponing communal activities, ceasing visitation, and screening staff and patients daily.” The early outbreak at Carolina Point eventually resulted in the COVID cases among 20 staff and 89 patients, with the deaths of 20 patients.

First of 36 veterans dies

The first death of a veteran in a COVID-related case came at the Kinston state veterans nursing home on April 21, of Benjamin Vincent Askew, 94, of Kinston, who served during World War II as a radio operator on a PV1 bomber in the Aleutian Islands.

Pruitt sent a statement to the Neuse News about the April 21 death: “We are saddened to share that a veteran at North Carolina State Veterans Home – Kinston passed away Tuesday, April 21 after testing presumptive positive for COVID-19. The veteran’s family has been informed, and out of respect for the situation, we will not be commenting further.”

One of Askew’s daughters, Jo Teague, 69, of Raleigh, said in a phone interview that Askew had developed a fever the last few weeks of his life, leading up to his death April 21.

“It would come and go, come and go, and then he had a urinary tract infection, I believe,” she said. “Two or three days before he died, they did some blood work and tests. They found out that he had COVID. But we don’t think that’s what killed him.”

Teague, a substance abuse counselor, said she was not aware of the private management of the Kinston veterans nursing home. However, both she and sister Ann Kohler, 74, of Virginia, seemed somewhat unclear about the complex web of relationships between the federal Department of Veterans Affairs, the local VA Hospital, the state-owned nursing home, the management company out of Georgia, and ancillary functions such as a hospice service.

“I really don’t know anything about that. I just know that dad’s facility was very, very kind and helpful, and professional,” Teague said.

‘You never think there’s enough’

The sisters expressed general positive feelings about the way the Kinston center was run by Pruitt, accepting as a given that health care facilities operate with too few employees.

“It’s like everywhere,” Kohler said. “You never think there’s enough help — especially at night and on the weekends. And experiencing a lack of communication sometimes between shifts.

“There are always money restrictions. And so there’s only so many people that you can have on the floor on the weekends and at night,” she said.

“I mean people can’t work seven days a week, 24 hours a day.”

In fact, for-profit providers like Pruitt must constantly deal with the tension between personnel expenses and winding up in the black. Staffing up requires more salaries and/or overtime, which can put a dent in profits.

“Staffing is a widespread problem in long-term care,” said Lauren Zingraff, executive director of the non-profit Friends of Residents in Long Term Care. “COVID-19 shone a very bright spotlight on how severe the staffing shortage problem is.”

Part of the problem, Zingraff added, is that long-term care staff are generally not paid a liveable wage.

“They have no health benefits, they have no benefits of any kind,” she said. “If they’re sick and they don’t come to work they don’t get paid.”

shows a group of people, many of them dressed in military uniforms, gathered around a pallet of boxes in the hallway of a building.
Before the days of COVID-19, local service groups would frequently visit the veterans homes. In this photo from Dec. 2016, members of Seymour Johnson Air Force Base, North Carolina, the Goldsboro Elks Lodge #139, and the local Wayne County community receive instructions before visiting with the residents of the N.C. Veterans Home, Dec. 24, 2016, in Kinston, North Carolina. More than 45 people volunteered to pass out goody bags and holiday cards to the veterans. Photo credit: U.S. Air Force/ Airman Shawna L. Keyes

‘No major issues … exist’

In 2015 the North Carolina Department of Administration delved into the contract relationship between state government and PruittHealth through the questioning of an unidentified Department of Veterans Affairs official that appears in a nine-page state report related to the deal. Among the exchanges:

C. Has the State ever performed formal background checks on the Management Company and its principles? Please note that CPA firms are required to perform due diligence checks to accept new engagements?

ANSWER: The State has not performed any “Background Checks” on the Management Company. Pruitt Health is a large HealthCare Provider and is required by Banking Institutions to have annual CPA reviews and Statements issued. The CPA firm is nationally recognized and will produce Statements.

E. How long has Management Company performed a contract for the State of North Carolina?

ANSWER: First contract was awarded in 1998 and every five year, the Management Company had to “bid” the contract for rendering services.

F. Any issues with the Management Company?

ANSWER: Normal business relationship exists with Management Company, minor problems do occur which is to be expected. No major issues have developed and none exist.

Role of private management questioned

Some nursing homes and other long-term care facilities tend only to attract attention for their failings. These centers encountered the problems they are facing now, in part, because of their complicated funding and reporting structures, a Duke expert said.

“There’s this mixture of federal, state, county regulation and oversight, the reporting up the chain is very different,“ said Nathan Boucher, a professor in the Sanford School of Public Policy at Duke University and a research scientist at the Durham VA.  “And that piecemeal, that patchwork, that mixed oversight of various things, it creates a problem.”

The veterans nursing homes run by Pruitt mostly score well on rankings by the Centers for Medicare and Medicaid Services, especially in the category of staffing, an element seen as crucial to care.

In its 2014 bid to retain its North Carolina contract, the company cited its “many deficiency-free licensure and certification surveys” among all its facilities.

As another recommendation, company CEO Neil L. Pruitt cited 70 awards to his facilities during a three-year period from the American Health Care Association. Known as AHCA, the industry group in 2013 named Neil Pruitt Jr. to the position of chair of its board of governors.

Pruitt, his father, and his wife Mebane have donated $138,076 to political action committees of the AHCA starting in 1987. Overall, CEO Neil L. Pruitt Jr. has made bipartisan donations of almost $1 million to candidates, political parties and PACs. In 2013, Sen. Mitch McConnell (R-Ky.) named Pruitt to the federal Commission on Long-Term Care.

“I’ve seen firsthand how post-acute care has evolved through the years and become a vital partner in the long term care continuum,” Pruitt said in a statement. “But we’ve never lost sight that it all hinges on quality.”

Problems before COVID-19

However, the federal Centers for Medicare and Medicaid Services recorded 47 health deficiencies between 2017 and 2019 at the Pruitt-run North Carolina veterans nursing homes.

Despite a relatively clean record, there have been significant deficiencies in Pruitt’s administration of veterans homes in North Carolina. A new report from the state Department of Health and Human Services says that the Pruitt-run veterans nursing home in Salisbury allowed dozens of relatives of ailing veterans to make drive-up car visits for 10 days in June. The visits came during a high-level alert at the home and despite federal and state bans on such visits.

This deficiency certification is an element that could be considered before December when Pruitt seeks its second renewal of its $207 million contract of 2015.

The deficiencies listed below happened eight years ago, well into Pruitt’s management of the veterans homes. They had been public record for two years when the state last asked for bids on the veterans nursing home management contract.

For example, a 2012 state report cited Pruitt’s Salisbury deficiencies for failures to:

  • Keep pressure sores from getting worse
  • Keep the medication error rate at 5 percent or less
  • Secure catheters for two residents
  • Throw away out-of-date meds
  • Post results of DHHS survey results
  • Provide proper dental care for a resident with only 12 teeth, one broken
  • Make sure two special locked doors open as mandated when a fire alarm sounds

Most of the recorded deficiencies were at lower levels, but Kinston recorded a high level (J-level) deficiency, indicating potential immediate jeopardy to a resident, with a note of past noncompliance.

Salisbury also had a J-level deficiency, under which it was told to make sure the facility was free of accident hazards.

The veterans nursing home, CMS said, should “protect each resident from all types of abuse including mental, sexual abuse, physical punishment and neglect by anybody.”

Most recent pre-COVID deficiencies in NC’s state veterans nursing homes

Only the most recent inspections by the state Department and Health and Human Services into the Pruitt-run homes do not cover the period in which COVID-19 infected residents of three of them.

A 2018 health inspection of the Salisbury home resulted in a finding of immediate jeopardy in the case of a resident who “eloped” or wandered away from the home. An unidentified police officer told inspectors that he had gotten a radio call about a missing veteran.

“Campus Police further revealed that he drove near the building and observed Resident # 6 immediately,” the state report said: “He reported [that] the nurse was coming up on him (Resident # 6). As soon as I shined my lights (sic), Campus Police further revealed that Resident #6 was sitting right across from the helicopter pad in front of Building 10 (the facility) in his wheelchair.”

Another inspection found that the Salisbury home had failed in 2019 to carry out the physician-ordered blood tests for two of six residents with cognitive disorders, one of whom went two weeks without testing for anti-coagulant status. Other residents failed to receive nutritional supplements as ordered, inspectors said.

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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