Originally Published: June 20, 2018 6:05 a.m.
The local VA medical center director declared on Tuesday afternoon that care for the most vulnerable, and difficult to treat veterans is today, and will remain, a top priority for the facility that just earned the lowest rating in the nation for its 85-bed nursing home, known as the Community Living Center (CLC).
In a telephone interview, Northern Arizona Veteran Affairs Health Care System (NAVAHCS) Medical Director Barbara Oemcke was clear the CLC’s 88-person staff, including their top medical personnel, take these matters seriously, and are already working to correct any and all deficiencies. Another inspection will be scheduled in July, and then a longer-term survey will be done sometime between January and April 2019.
The rating system for this score is brand new, and much of the data used was collected over the course of the last two to three years, Oemcke and other VA officials said. Some issues have already been addressed, and all the others are in the works, she said.
The federal VA conducts quarterly reports on all of its facilities, focusing on infection and death rates.
One key issue of concern highlighted in a June long-term institute care survey had to do with the center’s water temperatures, one that impacts all health care institutions, Oemcke said.
New mixing valves were installed at the CLC to assure water is hot enough to prevent Legionella bacteria but not so hot as to scald patients, Oemcke said. The problem is the initial valves did not work properly, with water still hotter than it should be, and so those valves were then immediately replaced so that now the water temperatures are where they need to be.
The VA has at no time had an outbreak of Legionella, with any bacteria found at low levels or in locations that did not impact any patients, Oemcke said.
Part of the low score is attributed to a patient survey related to a lack of proper pain management. Oemcke said finding a resolution to patient pain control proves tricky because staff do not want to overmedicate so patients are susceptible to falls and other injuries. On the other hand, staff also wants to be certain patients are not in acute pain during their stays, she said.
The CLC includes hospice care for end-of-life veterans — the VA’s annual hospice celebration in May recognized 160 veterans who passed in the prior year — and pain management is a key part of the process.
“We are working, carefully, to get the right balance,” Oemcke said, noting CLC staff are striving to ensure veterans’ pain is monitored at regular intervals from admission to discharge.
In talking about the scores, Oemcke said she and the top medical staff were adamant that this is a community that values veterans, and is devoted to their ongoing health care, and any changes that are to be made must value that mission. She said the VA could see a much more rapid score increase if they were to opt against offering this type of health service.
“But that is not our mission,” she emphasized.
Oemcke and her fellow medical staff agree that NAVAHCS must provide for those veterans who depend, and require, this more intensive brand of care, be it for surgical rehabilitation or long-term skilled, or hospice care.
She noted that a core value of this VA campus is to care for all veterans, including those with complex medical conditions.
The local VA represents about 27,000 veterans across 60,000 square mile of northern Arizona. Beyond the 164-acre main campus off Highway 89 that was once the frontier site of Fort Whipple, the VA also operates 11 satellite clinics that stretch from Lake Havasau City to Tuba City.
This is not the first time local VA officials have had to respond to less than stellar ratings, but certainly is the first time it has received such a low rating on a particular service.
One of the VA’s challenges has to do with the age of its buildings that date back to the 1920s. At this time, the VA is undergoing some $30 million worth of construction to expand and renovate facilities, with more expected to come in the future. The CLC is not on the renovation list at this time, but Oemcke said she expects there will be renovations or construction there in the future.
In contrast to the low score, Oemcke said the inspectors also cited some “best practices” that speak to the professionalism of the VA’s medical personnel.
The CLC staff earned the highest score — scores range from a low of 1 to a high of 5, Oemcke said. In the last month, VA officials cited the CLC’s clinical leadership for not only addressing the need for improvement but engaging staff, and patients, in the process.
She said they were impressed with the patient and staff interactions, with it clear how much patients care and admire their nurses and other caregivers.
Bottomline: Oemcke said the local VA is devoted to providing the very best care to its veterans. In the coming months, those efforts will be increased, and monitored. She said she expects progress to be made, acknowledging it will take time before the ratings reflect the improvements.
“It’s not just about the stars,” Oemcke said of the ratings. “We care deeply about the care and welfare of all of our veterans. We are really committed to learning, and improving, where we can. What concerns us most is the need to provide the best to the veterans we serve.”