Gaps remain in safety data on State Veterans Homes

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Years into the pandemic, long-awaited data on infection and deaths in special nursing homes for elderly veterans is marred by errors and inconsistencies that make it hard to know how well they have absorbed the lessons of the coronavirus as they face the Omicron surge.

A POLITICO review of data posted to the Veterans Administration website shows obvious statewide gaps and undercounts of deaths and illnesses in State Veterans Homes in Missouri, Mississippi and Illinois. At least three other states have significant gaps involving at least one of their homes, and more are sharing statistics that aren’t up to date.

State Veterans Homes in general performed quite poorly in the first year of the pandemic, with many having devastating outbreaks even as others managed to implement effective safety procedures that protected both residents and staff. The homes generally improved in 2021, as vaccines became available, but risks are now rising again. A VA spokesperson said the agency is not tracking booster rates in the state homes.

The homes suffer from what former VA Secretary David Shulkin has called a “hodgepodge” of state and federal oversight, with gaps in regulation and accountability, a five-month Politico investigation showed earlier this year. The VA pays for the homes, and commissions an annual inspection; the states own and operate them day to day. Some states require them to meet the same standards as civilian long-term care centers; some do not.

The Covid-19 death rate in the state homes was much higher than in a separate kind of long-term care for vets, known as Community Living Centers, which are run wholly by the VA.

The Veterans Administration, which dispatched emergency teams and resources to both the vets’ homes and civilian health facilities during the peak of the crisis, has acknowledged it needs to do better.

A report released this month assessing the VA’s overall national pandemic response recommended developing “an information system to facilitate monitoring State Veterans Homes for indicators of infectious disease risk.” It also said it is “working to become more proactive in support of SVH’s.” The report did not, however, cite any specific plans or timelines.

Congress has taken note, pushing for greater transparency and investing an extra $1 billion during the pandemic, directed at repairs and replacements of antiquated buildings with poor infection control. But lawmakers haven’t grappled systematically with a permanent fix to the divided state-VA oversight.

Data collection and dissemination mirrors and magnifies that fragmented authority and accountability. The 158 individual homes, state health and veterans’ agencies, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the VA itself all have a role in gathering the numbers; none has overarching authority. When a home doesn’t report its numbers on a given week, the VA just types in “—.” In some cases, the statistics that the states circulate don’t match those released by the VA.

Data matters, experts on epidemiology and long-term care say.

Data is more than numbers on a spreadsheet, they say. It’s a window into the quality of care, the competence and resources thrown into controlling the spread of a virus that’s killed one in 100 Americans over age 65 — and that’s building into a winter surge that may kill more. Faulty data means it’s harder for outside groups — veterans’ advocacy and service organizations, families, media, even other government officials — to hold the homes accountable for lapses in safety procedures.

About three-fourths do get CMS oversight, and their data is posted. For months, data was hard to find for the roughly four dozen homes that are not under CMS purview. In mid-November, the VA began posting much more detailed information on infection and deaths of both staff and home residents in all 50 states. But the VA doesn’t collect the data itself. It relies instead on what the homes and states submit — and some of it is still getting mangled or delayed.

The homes understand that more needs to be done, their national association said.

“The state homes have been addressing discrepancies on an individual basis as they are identified,” said Heyward Hilliard, president of the National Association of State Veterans Homes. “Within the state home community, there have been some deviations in reporting criteria and methods leading up to the current data sets. As these are further resolved, the number should agree. “

It hasn’t happened yet, not across the board.

For example, the VA’s publicly available data shows zero deaths in Missouri homes from May 25, 2020 to August 29, 2021. That’s incorrect — Missouri itself reported 103 Covid deaths by mid-November 2020, and commissioned a report by the St. Louis-based law firm Armstrong Teasdale on missteps and how to correct them. That report was made public.

Aimee Packard, spokesperson for the Missouri state veterans agency, attributed the inconsistencies to technical snafus. “We are actively working with the VA on a historic data upload issue that is affecting our case counts between the beginning of the pandemic to around January 25, 2021,” she emailed. As of earlier this month, Missouri had no Covid deaths in its state vets homes in 2021, she added.

In Mississippi, a state Veterans Affairs spokesperson shared data with POLITICO earlier this fall that showed its four homes had 434 cases and 111 deaths between April 2020 and Sept. 22, 2021. He shared state totals, not a site-by-site breakdown of the homes, which can serve 600 people at any given point in time. But the VA site shows a maximum of 87 cases and 10 deaths between May 25, 2020, and Sept. 29, 2021.

Illinois makes its tallies available on a state website but those numbers don’t match the VA site. For instance, a state report said Illinois’ LaSalle home had an outbreak that began in November 2020 and caused some 109 cases among veterans and 116 among staff. By contrast, the VA chart showed 10 cases for patients, 18 for staff. At Illinois’ Manteno home, 48 veterans and 33 employees were sickened in an outbreak between early May and June 2020, according to state records. The VA shows 31 employees and at most 10 veterans fell ill there between May 25, 2020, and September 2021.

A spokesperson for the Illinois veterans office said she had no explanation for why the VA numbers were wrong. The state had submitted correct numbers, and its local liaison with the federal VA had confirmed their accuracy. “We do not know why this report does not reflect the accurate data,” she emailed.

Several other states have anomalies. But in other cases, reporting is improving. For instance, Nebraska data was missing earlier this fall; it’s now coming in.

For political leaders and advocates for veterans, the fight for full and accurate information on cases and fatalities has been long and frustrating.

“On behalf of the men and women who served our country, I will continue working with my colleagues on both sides of the aisle to hold the [VA’s] feet to the fire to provide full, accurate, and timely data to Congress and the public,” Senate Veterans Affairs Committee Chair Jon Tester (D-Mont.) told POLITICO in an emailed statement. “That’s how we ensure states and VA are providing the best possible care veterans deserve.”

Since May 2020, CMS has required long-term care facilities to submit data to the CDC — illness and death rates for both residents and staff.

CMS began posting the information on civilian nursing homes as well as the veterans facilities it oversees. But the agency said it wasn’t responsible for public release of the roughly four dozen veterans homes it didn’t regulate. Most of those were “domiciliary” facilities, which is more like assisted living. (Some homes had a mix).

Congress in a sweeping appropriations bill passed in late 2020 required the VA to plug that gap and report all state vet home data. But the legislation was not clearly written; the VA insisted for months it only had to report aggregate totals, not a home-by-home breakdown. Nearly a year later, under pressure from Congress, and as POLITICO was reaching out to every single home where the data was missing, the VA began disclosure.

The House and Senate Veterans Affairs Committees have pushed the VA, and the Government Accountability Office is reviewing the VA’s oversight and transparency. But it hasn’t become a top-tier issue for Congress overall.

“VA and states have a shared responsibility to oversee the quality of veterans’ care at State Veterans Homes, and we need better transparency when it comes to that oversight,” Tester added in his statement.

But the VA so far hasn’t signaled much of an appetite for change. When Sen. Chuck Grassley (R-Iowa) earlier this year sent VA Secretary Denis McDonough a list of questions about oversight, the VA responded, “VA has no recommendations at this time, and we are always glad to discuss with Congress ways to improve the oversight system of SVHs.”

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