Talihina Veterans Center to phase out special needs unit
Rocked by troubling deaths and a severe nursing staff shortage, the Oklahoma Department of Veterans Affairs has quit accepting residents with behavioral issues at the Talihina Veterans Center and begun phasing out its 48-bed special needs unit.
The special needs unit is where care is provided to aggressive residents, residents with a history of walking away without telling staff, and veterans with dementia or Alzheimer’s disease who tend to wander.
“This is not our first choice to do,” said Executive Director Myles Deering, a retired major general. “We’re trying to serve the veterans in this community as best we can, but we can’t go on with limited staffing administering to the number of residents we have. It’s necessary that we make this move in order to protect the residents.”
The 175-bed Talihina Veterans Center has come under scrutiny in recent months because of two high-profile deaths. Vietnam War veteran Owen Reese Peterson, 73, was found with maggots in his body and later died from sepsis at the center on Oct. 3. About three months later, Leonard Smith, a 70-yearold advanced dementia resident, choked to death. A plastic bag was later found lodged in his throat.
Administrators say obtaining adequate nursing staffing for the Talihina Veterans Center has long been an issue because of its remote
location in a heavily forested region of southeastern Oklahoma.
‘It’s in a death spiral’
The center has offered enhanced pay in an effort to fill positions, but still has 34 vacancies on its 162-person resident care staff, said Doug Elliott, deputy director of the Oklahoma Department of Veterans Affairs. The center has had to resort to 12-hour nursing shifts, which has made recruiting even more difficult.
“It’s in a death spiral,” Elliott said.
Talihina Mayor Don Faulkner called the staffing argument “pretty bogus.”
Faulkner claims the center was fully staffed when Deering became director two years ago — a claim that Elliott denies. The mayor said talk about relocating the facility has prompted employees to leave in search of stability.
Faulkner said the Kiamichi Technology Center, Eastern Oklahoma State College and Choctaw Nation all have expressed a willingness to work with the center to resolve staffing issues.
State veterans department administrators have recommended relocating the facility to a more heavily populated area within southeastern Oklahoma.
State Sen. Frank Simpson, R-Springer, authored legislation to accomplish that.
His Senate Bill 544 calls for relocating the center to a city of at least 8,000 people located within 40 miles of the Talihina facility. The bill is currently awaiting action in the House of Representatives, where it faces opposition from Talihina community leaders concerned about the financial impact that the loss of jobs would have on the town of about 1,100 people.
Faulkner said state veterans officials have been pushing to move the center to Poteau, because of its nearness to a bigger labor pool in Fort Smith, Arkansas, but complained that would mean a lot of jobs would be going out of state.
Meanwhile, problems at the 95-year-old Talihina Veterans Center continue to mount.
The center, originally constructed in 1921 as a tuberculosis sanatorium, has mold issues in the special needs unit that would cost $8 million to correct, Elliott said.
The center actually needs about $22 million in repairs and improvements, which is about what the state’s share of costs would be to build a new facility, Sen. Simpson said.
Attracting residents to the center has been a problem. The special needs unit currently has 31 residents and 17 vacancies, Elliott said.
“All our other centers have waiting lists, some up to 300,” he said.
Since December, inspectors have written up the center three times for violations that placed residents in immediate jeopardy, Elliott said.
In December, federal VA inspectors found an immediate jeopardy situation occurred when a veteran on oxygen stepped out the door to smoke with a cigarette in his mouth and lighter in his hand, said Tina Williams, clinical compliance director.
Federal officials temporarily halted admissions to the center at that time, but the restriction was later lifted.
State health department inspectors subsequently cited the center in February for an immediate jeopardy for failing to assess a resident properly, which resulted in an inappropriate care plan for the veteran who died from choking on a plastic bag, Williams said. The inspection came after the center self-reported the incident.
Inadequate staffing and supervision led to another immediate jeopardy citation in March, she said.
Administrators said they are now concerned that federal officials could take actions that would result in closure of the facility unless they make major changes.
By making the decision to phase out the special needs unit, administrators are hopeful they can provide adequate staff for the 127 beds that will remain and return to 8-hour shifts for the nursing staff, Elliott said.
Falling on families
The department plans to move those residents to other Oklahoma veterans facilities as space becomes available. After June 1, special needs unit residents who refuse to transfer to other Oklahoma veterans centers as openings occur will be required to move to other nursing homes or back home to their families, Elliott said.
Faulkner said family members of some veterans broke down in tears when informed of the upcoming forced move.
“I am very upset that they’re shutting this down,” said Karen Ward, whose dad has dementia and resides in the unit that is being phased out.
Ward said she hasn’t noticed staffing problems. She said the center is in a picturesque setting, her dad has adjusted well and many family members live close by which makes it easy for them to visit. Ward said she dreads disrupting all that.
“The facility is not crumbling down. It’s been renovated. I just cannot believe they’re trying to shut this thing down and shutting the dementia ward down June 1,” she said.
Sen. Simpson said he supports the department’s decision to phase out the special needs unit, but the Talihina center and other Oklahoma veterans centers ultimately need to be replaced.
“The consequences of this bill not passing would be catastrophic,” Simpson said. “We will lose a veterans center if we do not right now start planning to relocate that facility. We are going to lose it completely and we will lose those beds and we will never get them back.”
Simpson said his bill would inform federal VA officials that it is the Legislature’s intent to move the Talihina center, but would not provide funding for the relocation. Ultimately, the federal government would pay 65 percent of the cost of a new facility and the state would have to provide the other 35 percent, he said.
Simpson said the Talihina center and Oklahoma’s other state veterans homes care for residents in institutional settings that are not good for their psychological or physical well-being.
Research has shown small-house concept homes are much better, he said.
In small-house concept homes, a small group of residents will live in a home where each has a private bedroom and a private bath, and they share a common central dining room, living room, den and kitchen, he said.
Simpson said he visited one of these modern-concept homes three or four weeks ago in Tyler, Texas.
“They found a phenomenal thing,” Simpson said. “Once they moved veterans out of the institutional environment and into the small-house units at Tyler, they saw a dramatic decrease in cases of depression, and the need for psychotropic drugs dropped by 80 to 90 percent.”
“The research is so compelling that the USDVA will no longer fund institutional type settings for veterans centers,” he said. “They will only fund the small-house units.”
Simpson said replacing the Talihina center with small house concept homes is just the first step in what needs to be done in Oklahoma. All the institutional centers need to be replaced with small-concept homes, he said.
“It is such a better quality of life than what we are offering our veterans,” he said. “What we are currently doing ... is warehousing our veterans in these institutions until they die. I think we can do better than that.”
Faulkner said in 2014 there were discussions about expanding the Talihina center by constructing a home like the ones in Tyler next to it that could be used for healthier residents who were ambulatory. They could transfer to the existing facility if their physical conditions deteriorated, the mayor said, adding that was an idea he would support.