Director explains low rating at VA nursing care facility

Oklahoma’s only federally run VA nursing care facility received a one-star quality rating, the worst possible, according to internal records recently released by the Department of Veterans Affairs.

Almost half the 133 federal VA nursing homes received the one-star quality rating, based on the department’s own internal benchmark standards.

This is the first time the VA has made internal quality information public.

The records did not include detailed information or inspection reports on individual facilities or the measures used to gauge quality, but according to USA Today and The Boston Globe, which broke the story earlier this month, quality ratings are based on 11 indicators, including the rate of antipsychotic medication prescribing, the number of cases of bedsores and catheters left in for long periods of time.

Wade Vlosich, medical center director for the Oklahoma City VA Health Care System, said the low score is attributable to the kind of care provided at the Oklahoma City facility as well as technicalities in the rating system, not poor quality of care.

The center, located at 921 NE 13 Street, is small, with only 31 beds, and does not have a longterm care unit or fit the mold of traditional nursing homes. Instead, there is a short-stay rehabilitation unit for veterans recovering from surgery and a palliative care unit which provides endof-life care and specialized care for those with severe, incurable medical conditions.

As a result, of the 11 quality indicators, the center is graded only on the three that apply to short-term patients.

“It’s not apples to apples,” Vlosich said of the quality rating. “We have very high standards when it comes to quality of care in numerous aspects and I know the perception is that that’s not there, but it is.”

But in at least two of the three areas that are measured, the Oklahoma City facility performs worse than the national average.

While 31.35 percent of VA patients nationwide reported pain, the figure was 38.61 percent at the Oklahoma City center. Vlosich said the higher figure is due to Oklahoma City’s palliative care unit, which by its nature houses patients who have higher levels of pain and discomfort.

Oklahoma City also reported a higher use of antipsychotic medicine. Local officials again cited the nature of the palliative care unit and patients housed there. Anti-psychotic medicine and opioids are used to help deal with nausea and hallucinations, said Saleem Qureshi, chief of services for geriatrics and extended care at the Oklahoma facility.

“(The VA) population not only commonly has symptoms of nausea and vomiting, but also the prevalence of delirium at the end of life,” Qureshi said. “We know what is being measured, but what’s most important to us is that we are taking the best care of the patients as possible and each one needs our specific attention and customization and that’s what we do.”

The use of antipsychotics in long-term nursing homes has drawn attention for years. In 2012, the federal government started a program to improve nursing home care by lowering the use of antipsychotics. Recently, Human Rights Watch released a study that found thousands of patients still were unnecessarily receiving such drugs.

Oklahoma VA staff members say they’re hoping more accurate measures are developed that take into account the kind of treatments provided at different facilities, Vlosich said.

“They are looking at different ways to measure it because we are not the only place that has brought that up,” Vlosich said. “When you’re weighted on a scale from the best to the worst, we’re always going to be down there until they can figure out how to pull out these palliative care sections from the data.”

In addition to quality, the VA report also graded facilities on two other measures — staffing levels and a customer satisfaction survey.

The Oklahoma facility received the highest rating available, five stars, for its staffing levels, and a four-star rating for its survey.

Overall, the facility received a four-star rating, one of 73 federal VA facilities nationwide to receive a rating that high.

In addition to the federally run facility in Oklahoma City, the state operates seven VA nursing homes throughout Oklahoma.

Given that both the state and federal facilities operate with tax dollars, Robyn Grant, director of public policy and advocacy for the National Consumer voice for Quality Long-Term Care, said both should provide the same public information required of all Medicaid- and Medicare-certified facilities.

“It has been very troubling to learn that there’s been quality indicators and inspection reports that the VA has been using and not allowing veterans and families and the public to access,” Grant said. “I think this is a step in the right direction, but it is long overdue and is certainly not enough. Veterans and their families have the right to access this information.”