CLCs Fared Well

Meanwhile, VA’s CLCs have gone relatively unscathed during the pandemic. At a House VA oversight subcommittee hearing in July VA reported that only two of its 7,500 veteran CLC residents nationwide were currently identified as positive for COVID-19. At a previous hearing, VA officials credited CLC’s high number of trained nurses and physicians, their proximity to VA medical centers and a rigorous infection control system for their success.

During the pandemic, VA officials have worked with state homes to help teach best infection control practices. But officials wonder if that assistance should have come sooner.

A 2019 Government Accountability Office report on state veterans homes found that, in some cases, VA is the only agency providing regular oversight of those facilities. Homes that are not licensed by the state and are also not enrolled as a Centers for Medicare and Medicaid Services (CMS) provider are not inspected by either. However, VA is prohibited from making payments to any home before proving that they meet quality standards, and so the department conducts annual inspections.

The report found that VA usually contracts out such inspections and that the inspections are more lax than similar inspections conducted at CLCs.

For example, VA’s contractors were not identifying all failures at state veterans homes as “deficiencies.” Instead, low-level deficiencies that were deemed to have minimum risk were written down as “recommendations.” Consequently, while CLCs averaged four deficiencies per inspection, state homes only averaged one. 

During GAO’s investigation, VA officials admitted that it was the collegial relationship with state veterans homes that led to this low number and that contractors also allowed for on-site corrections so homes could avoid deficiencies on their report. 

Sharon Silas, GAO’s director of healthcare, told the subcommittee that, while recommendations made in the watchdog’s 2019 report were pointed at improving inspections, she couldn’t testify that they would have prevented the wildfire spread of COVID-19 at these state veterans homes. Silas did note, however, that other investigations by GAO suggest that a lax accounting of low-level deficiencies could have an outsized impact on infection rates.

“In some other work GAO has done looking at nursing homes, infection control deficiencies were the highest type of deficiencies they had. And a lot of those were cited as low-level deficiencies,” she explained pointing to “a simple thing, such as washing hands, which, we know now, has a huge impact.” 

VA officials argued that, while they had some influence, the final responsibility lies with the managers of the state homes.

“While VA has qualifications that must be met in the initial certification survey and our annual survey, truly the operational aspect of that is in the lap of the state,” explained Teresa Boyd, DO, VA’s assistant undersecretary for clinical services. “It is state-run, and we respect the autonomy of the state in operational oversight.”