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RHODE ISLAND VETERANS HOME UNDER SCRUTINY --

"Some of our investigations have revealed troubling

administrative patterns in the Veterans Home."

 

 

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Veterans Home under scrutiny

By Alex Kuffner
Journal Staff Writer

BRISTOL — Frederick E. Alger says that in the seven years he has lived in the Rhode Island Veterans Home he has been ordered to take 35 mental competency evaluations.

He says that on each occasion he has been deemed competent, but administrators at the state-run home have continued to have him take the oral evaluations, which typically include questions that test his knowledge of place, date and environment.

Alger, an 84-year-old World War II veteran, suffers various physical ailments, uses an electric wheelchair and breathes with the help of an oxygen tank, but he has not been diagnosed with any psychological problems.

Alger is an outspoken critic of the way the home is operated and has frequently butted heads with administrators. He is in the middle of his third two-year term as president of the home’s Residents Council, a group that represents the 250 veterans who live at the facility.

He believes the repeated evaluations are attempts by members of the administration to undermine his standing.

“I have a big mouth and everyone knows it,” he says. “They want to quiet me.”

Alger’s allegations are described in a preliminary report from a special legislative commission studying the administration and operation of the Veterans Home in Bristol. The study is ongoing, and the commission won’t issue its final report until the General Assembly’s next session in January.

Alger is not named in the report, which says that “reliable sources” provided details to the five-member Special House Commission to Study Potential Administrative and Functional Improvements at the Rhode Island Veterans Home. He confirmed that he is the resident in question.

“Our informant suggested that … this excessive number of competency consultations was motivated largely by the administration’s frustration with the patient’s advocacy on behalf of Veterans Home residents,” the report says.

THE SPECIAL commission’s 11-page interim report, dated July 6, is highly critical of some parts of the home’s operation, finding signs of problems in the nursing system, low morale among staff members, antagonism toward residents or their families who complain or challenge established procedures, and abuse of policies concerning the authorized release of information to families.

The report tells Alger’s story and the stories of two families who disagreed with administrators over resident care and, in separate incidents, said they were threatened with arrest.

“Some of our investigations have revealed troubling administrative patterns in the Veterans Home,” the report begins.

The report, however, cautions that many of the allegations are based on anecdotes from a small sample of respondents that have yet to be confirmed.

In an interview, the commission’s secretary said the problems alleged at the home are not criminal but do raise concerns.

“Nothing we’ve seen or heard is criminal,” Marguerite Peruto said. “Some of it is nasty, mean or cruel, but nobody’s going to jail. I do believe the care there is very good despite the management problems. We’re trying to take the best place there is and make it better.”

The commission’s work so far has elicited strong reactions from supporters and critics alike.

Rep. Kenneth Carter, D-North Kingstown, chairman of the House Veterans Affairs Committee, says the report has raised some troubling accusations.

“The things that they said in the report should never happen,” Carter, a Navy veteran, said. “If they continue to do the things that this report says are happening then something has to change, whether it’s management policies or personnel.”

But Roberta Hawkins, the state’s long-term-care ombudsman, called the report “unreliable,” noting that the commission itself couldn’t verify some of the allegations it wrote about.

“It’s too soon to say whether this report has any weight,” Hawkins, director of the Alliance for Better Long Term Care, said.

Nevertheless, the report has raised enough questions to warrant further investigation. Governor Carcieri has asked for an internal review of the administration of the home by the state Department of Human Services.

THE RHODE ISLAND Veterans Home opened in 1891 to care for the state’s combat veterans. Any veteran who has served during a time of war and was honorably discharged can apply for a bed there. Residents must pay a monthly fee equal to 80 percent of their income.

Until recently, the facility’s use as a retirement home, without a large focus on medical care, stayed much the same. That mission, however, has changed over the last two decades as the need for long-term nursing care for Rhode Island’s aging veterans — most of them from World War II — has increased.

The special commission was formed under a House resolution sponsored by Carter, largely in response to the bureaucratic and physical problems at the Walter Reed Army Medical Center, in Washington, D.C.

The Veterans Affairs Committee had already formed a separate commission early this year to look into whether the Veterans Home, which was rebuilt in 1955 and expanded three times thereafter, needs further renovations or should be replaced entirely. During that study, which has yet to be completed, legislators have also heard concerns about how the home is run.

The second commission was formed to look specifically into the home’s operation.

The commission is chaired by H. Reed Cosper, the state’s mental health advocate, and includes Frederic G. Reamer, a professor of social work at Rhode Island College; Dr. Marc S. Weinberg, an associate professor of medicine at Brown University’s Medical School; Edward Lyons, director of admissions at Butler Hospital; and Peruto, an addiction counselor at the nonprofit CODAC, which operates treatment centers in the state.

OVER TWO HOURS at a hearing July 26 inside the Rhode Island Room at the Veterans Home, the commission heard testimony from residents, staff and families. It was the commission’s fourth meeting, and 80 people were in attendance. An American flag hung on one wall, next to a bingo scoreboard.

Many of the complaints during the public meeting seemed to relate to the often mundane inefficiencies at any large institution.

One resident, wearing a T-shirt emblazoned with “Home of the Brave,” told the panel’s members that the facility needed better exercise equipment. A man in a wheelchair complained about the high fees for cable television. Another resident complained about the poor selection in the home’s convenience store.

One veteran took the microphone and announced that he had no complaints and was happy living in the home.

Jack Callaci, director of organizing and bargaining for the United Nurses and Allied Professionals union, told the commission that its report was premature.

“We didn’t think the evidence was anything more than anecdotal,” said Callaci, whose union represents 45 registered nurses at the home.

Nurse Adrienne Camara, the union’s representative at the home, responded to the report’s allegation that the facility’s reliance on temporary workers could lead to problems in care.

All temporary nurses, she said, must go through an eight-hour training session before they can work with residents. Twelve workers, she said, had passed through the program since it was started in June.

“We do everything we can to make it a safe and comfortable environment for our residents,” she said.

IN THE AUDIENCE at the hearing were Barbara A. Crowley and her mother, Carolyn Crowley. They did not testify, but their interactions with the home’s administrators are detailed in the commission’s interim report. They are not named in the report.

From the time her grandfather, Raymond H. Parent, a World War II veteran, moved into the home in 2002, Barbara Crowley said there were disagreements between her family and staff over his care and which doctors he would be allowed to see.

The arguments centered on Parent’s mental competency and his family’s involvement in his medical choices, according to Crowley. She said her mother had what’s known as health care durable power of attorney, which allowed her to make decisions about Parent’s care. But Crowley said administrators at the home soon stopped notifying her mother about Parent’s medical treatment.

Crowley said family members were excluded from Parent’s care because they were identified by administrators as troublemakers.

The discord culminated in an argument after Director of Nursing Jan Markoff threatened to call the police when she saw Crowley photographing a broken table in Parent’s room, according to Crowley. Markoff did not follow through on the threat.

At the time, the Crowleys were working to transfer Parent to another nursing home, but the next morning, May 15, Parent died. He was 89.

The Crowleys filed a complaint with the state Department of Health about their treatment by administrators at the home. According to Jeff Neal, a spokesman for the governor, the department investigated the allegations but did not cite the Veterans Home for any deficiencies.

DEBORAH BACUR’S experience at the home is also described in the report. Though she too is not identified, she said she’s the person in question.

Her father, Albert J. Bacur, a World War II veteran with Parkinson’s disease, moved into the home last year. She said her dealings with administrators grew problematic after she disagreed with her father’s decision to stop seeing his long-time physician at Rhode Island Hospital and start seeing a doctor at the home.

Bacur said she complained to administrators after her father fell on two separate occasions. When he developed infections, Deborah Bacur wanted to take him to an infectious disease specialist, but, she said, administrators disagreed.

The arguments escalated, and administrators, believing Deborah Bacur was a disruption, restricted her visitation hours to weekdays, she said.

On Thanksgiving last year, she had dinner with her father at the home. She said she complained to workers in the cafeteria because she and her father did not get any white meat with their dinners. Soon afterward, she said, two nurses approached her and told her that a cafeteria worker had complained to Markoff about her. According to Bacur, the nurses told her that if she didn’t leave, Markoff had given instructions for them to call the police.

Afterward, on several occasions, Bacur met with administrators to try to reach common ground, but she said the meetings were unproductive. The last meeting was scheduled for May 8, but it was canceled. Albert Bacur died that day at the age of 87.

In assessing the allegations made by Deborah Bacur and the Crowley family, the special commission says in its report that it appears administrators at the home “established an artificial informational and treatment wall.”

“Based on widely accepted ethical standards in health care, it is the duty of health care providers to facilitate the involvement of persons whom a patient authorizes to participate,” the report says. “It appears that Veterans Home administrators obstructed rather than facilitated.”

FREDERICK ALGER was also at the July 26 hearing, sitting in his wheelchair with a “Support the Troops” bumper sticker on the back of the seat.

After the commission started its investigation in June, he gave permission for its members to see his medical records. According to the report, when an unidentified commission member — Peruto said it was she — went to the home on June 27 to go over the records, two staff members blocked access. The director of nursing “was directly involved in this obstruction,” the report says.

After Dr. Weinberg, the vice chairman of the commission, intervened, Peruto was allowed to see the chart, but found only seven pages of psychiatric data that did not document all 35 of the reported competency tests. The next day, the home’s administration gave Alger more documents.

However, the report says, “The patient’s statements indicate that more records are still missing.”

Asked in an interview to comment on the high number of competency evaluations described in the commission’s report, Kathleen Heren, the clinical director of the Alliance for Better Long Term Care, would not talk about Alger’s case specifically but did discuss the use of the exams in general.

She said a patient could be given multiple competency tests if he suffers severe physical ailments that may affect his mental state. A patient may also be tested for competency if his decisions interfere with his medical care.

“If there was an accumulation of competency evaluations, it’s because he wasn’t following that medical plan,” Heren said.

The alliance was contacted by the families of Parent and Bacur to look into the patients’ care. Neither Heren nor Hawkins, the alliance’s director, would talk in detail about the cases, but Heren did say that in some instances families can obstruct patient care.

“Sometimes families misbehave,” she said. “My only goal is to protect patients. If they’re competent, then I don’t care what the family thinks. We don’t always stick up for the families. And we don’t always stick up for the home.”

The alliance closely monitors the home. It has a volunteer ombudsman there, and Heren and Hawkins regularly visit. Hawkins said there is no question about the high quality of care in the facility. If there are problems, it lies with the home’s administration, she said.

“I think the administration doesn’t back the nursing staff,” she said. “I think the administrator is weak there.”

But Callaci, the union official, disagrees. The home, he said, is inspected by state and federal officials annually. The home passes those inspections every year, he said.

“If we all can agree that the care there is pretty darn good, then how bad can the administration be?” he said.

David Kirchner, the home’s administrator, and Daniel Evangelista, the state’s commandant for veterans affairs, did not return calls seeking comment.

GOVERNOR CARCIERI was briefed on the report soon after it was sent to him on July 9, Neal said. The governor asked Department of Human Services Director Gary Alexander to investigate the allegations further.

Neal noted that the potential problems written about in the report focus on management and administration, not the quality of care at the home.

Alexander, who was appointed acting director of human services in December before being permanently named to the position last month, highlighted what he says is the high level of care at the facility.

“If you interviewed a cross-section of families, you’d find that most patients and their families are very pleased with the care,” he said.

He added, “Might there be some changes that take place at the home? There might be. I tend not to rush to judgment. I want to make sure I do a thorough review myself before I do anything.”

The commission is set to issue its final report in January, but Carter has asked for a second interim report to be issued in the coming weeks.

If more problems are found or if the issues described in the current report persist, he said, he will ask House Speaker William Murphy to schedule special hearings before the House Veterans Affairs Committee.

“If things aren’t changing, then we need to look at what’s going on there,” he said. “I think we’ve got a great facility there. We’ve got great staff who work there. But I think management needs to be shaken up.”

akuffner@projo.com

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Larry Scott  --