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Officials cite reasons for Brockton VA nursing home's low quality rating

The Enterprise - 6/20/2018

BROCKTON ? Nursing home ratings posted for the first time by the federal government gave facilities at the Brockton VA campus just one star out of five for quality.

But doctors for the VA Boston Healthcare System, which operates the Brockton campus and the nursing home services provided there, said there's more to the story behind the quality ratings.

The Brockton VA was one of 58 around the country to receive one out of five stars for nursing home quality, out of 133 VA nursing home care centers operated by the agency. Out of the six located in New England, the one at the Brockton VA and another at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford were the only one-star quality nursing homes.

However, while the Brockton VA nursing home facilities received just one star for quality, it received five stars for staffing. The Brockton VA nursing home also received two out of five stars for its results on a surprise survey conducted by the Long Term Care Institute.

Lastly, based on a complicated calculus involving the other categories, the Brockton VA nursing home services received two "overall stars." Of the 133 VA nursing homes around the country, there were 40 VA that received two overall stars or less.

Acting VA Secretary Peter O'Rourke said it would be a priority to improve scores at the 11 facilities that received one out of five "overall stars," calling it the best comparison point between VA nursing homes and those in the private sector, using the Nursing Home Compare service.

O'Rourke's agency said the "unique patient base" served by VA, with a higher proportion of clients with conditions such as post-traumatic stress disorder and prostate obstructions, makes it "more challenging" to match the quality star ratings of nursing homes in the private sector that can selectively admit patients based on clinical matters. VA will not refuse to service any eligible veteran, the agency said.

Steven Simon, the chief of geriatrics and extended care for the VA Boston Healthcare System, said the issue of a "complex patient population" is even more pronounced at the nursing home facilities at the Brockton VA campus, which is one of six VA facilities with nursing homes connected to spinal cord injury units. There are roughly 30 patients being cared for at the spinal cord injury unit in Building 8 a the Brockton campus, who are categorized as part of nursing home patients along with about 90 others in the "community living center" in Building 4.

Simon said since a large number of patients in the spinal cord unit need to use indwelling urinary catheters, "by virtue of having these patients," it results in lower scores on a quality rating category for patients that have catheters left in their bladders.

Another indicator for quality stars is the percentage of patients who within the last five days experienced pain. For spinal cord injury patients, chronic pain is "a hallmark of their condition," Simon said.

Furthermore, Simon said there is no such nursing home in the community that is attached to a spinal cord injury unit.

Still, Simon said he and others on the VA Brockton team use the quality ratings to motivate themselves to improve the care available at the nursing home facilities.

"In this center, we strive everyday with all of our processes, with all of our employees, to help improve our care," Simon said. "We're very proud of the care we delivery and our mission to serve all veterans. The community living center in Brockton is a really unique place. Roughly a quarter of the patients are in the spinal cord injury center. Many are paralyzed from the neck or waist down."

Simon said the population at the Brockton VA nursing home is also complex because of the amount of patients with simultaneous chronic illnesses, with veterans suffering from mental illness and substance abuse. Another indicator for quality stars is the percentage of patients at a nursing home that received anti-psychotic medication.

"This is similar across the country," Simon said. "We are unable to select our patients. We take all eligible veterans, resulting in a care population here and across the country that has a lot of comorbid conditions."

The quality measurements for the recent star ratings have been taken regularly since 2016, ending with the second quarter of fiscal 2018.

"We welcome the opportunity to have transparency and to have our care examined by the public," Simon said. "We are honored and grateful to have the opportunity to serve our vets in this community. For many of them, it's the only place they are able to go, unlike community nursing homes, which can select their patients and choose them on the basis of clinical matters. We accept all veterans. We are very proud of that and the quality of care we deliver to them."

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