Secret data: Most VA nursing homes have more residents with bed sores, pain, than private facilities

By Donovan Slack, USA TODAY, and Andrea Estes, The Boston Globe | USA TODAY

Show Caption Hide Caption Life in a VA nursing home: One veteran’s story Don Ruch’s family thought round-the-clock care would help him recuperate, but he ended up in intensive care in septic shock, suffering from “severe” malnutrition, bedsores on his pelvis and back, a burn on his right thigh and a trauma wound.

An analysis of internal documents shows residents at more than two-thirds of Department of Veterans Affairs nursing homes last year were more likely to have serious bedsores, as well as suffer serious pain, than their counterparts in private nursing homes across the country.

The analysis suggests large numbers of veterans suffered potential neglect or medication mismanagement and provides a fuller picture of the state of care in the 133 VA nursing homes that serve 46,000 sick and infirm military veterans each year.

More than 100 VA nursing homes scored worse than private nursing homes on a majority of key quality indicators, which include rates of infection and decline in daily living skills, according to the analysis of data withheld by the VA from public view but obtained by USA TODAY and The Boston Globe.

The news organizations reported last week that 60 VA nursing homes received the agency’s lowest quality ranking of one out of five stars last year, but the data didn’t detail how individual facilities scored on specific measures. USA TODAY and The Globe are publishing the full data, outlined in internal documents, for every VA nursing facility as of Dec. 31, 2017.

Four VA facilities – nursing homes in Bedford, Massachusetts; Chillicothe, Ohio; Tuscaloosa, Alabama; and Roseburg, Oregon – lagged private nursing home averages on 10 of 11 indicators. At all four, about a third of residents were given anti-psychotic drugs – almost twice as much as in the private sector. The FDA has said such drugs are associated with an increased risk of death in elderly patients with dementia.

“They should be assessing individuals and doing what they can to manage it,” said Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care. “And if it’s not working, they should be trying different things.”

The VA, which has argued that its residents are typically sicker than those in private facilities, has tracked the detailed quality data for more than two years but has kept it secret, depriving veterans of potentially crucial health care information.

VA 'evaluating' what information to release

VA Press Secretary Curt Cashour has declined to answer questions about whether or when the agency planned to release the quality information, as well as nursing home staff data the VA has compiled dating to 2004. He also declined to say when the VA would release inspection reports the agency has kept secret for more than a decade.

After the investigative report by USA TODAY and The Globe last week, Louisiana Republican Sen. Bill Cassidy and Alabama Democratic Sen. Doug Jones introduced legislation that would force the VA to release all of its nursing home quality information at least once a year.

“We cannot work with this administration or any administration to fix the VA if we don’t have the information,’’ Jones said.

That measure and another introduced last week requiring the VA inspector general to investigate low-ranking VA nursing homes passed the Senate Monday as part of a government funding bill. House and Senate lawmakers will have to work out differences between their versions of the bill before final passage.

Acting VA Secretary Peter O’Rourke told the CBS affiliate in Dallas last week that VA officials were “evaluating exactly what is the most appropriate for us to put out there and that will support continuous improvement and then also will provide good decision-making information for veterans.”

He called the USA TODAY and Globe reporting on the VA nursing home ratings “fake news.”

Federal regulations require private nursing homes to disclose voluminous data on the care they provide. The federal government uses the data to calculate quality measures and posts them on a federal website, along with inspection results and staffing information. But the rules don’t apply to the VA.

Playing 'hide the ball' with nursing home data

The VA has used similar data internally to track quality at its nursing homes as far back as 2011, according to a report in October that year from the nonpartisan Government Accountability Office. At that point, the agency monitored at least two dozen factors, including how many residents had bedsores or were in serious pain. But none of the information was released.

The 2011 review found that 80 percent of the agency’s nursing homes had problems with medication management, but VA headquarters wasn’t using the data “ to detect patterns and trends in the quality of care and quality of life within a (VA nursing home) or across many (of them).”

The VA launched another tracking system in May 2016. It now measures 11 indicators – the same as those used for private nursing homes – and assigns star ratings based on the indicators, which can be clues to larger problems with overall quality. For example, high rates of falls or bedsores may indicate neglect.

In the first 18 months under this new tracking system, VA nursing homes scored below private averages on eight of 11 indicators, according to internal documents and minutes from an advisory committee meeting.

By the end of 2017, the VA scored worse on average than their private sector counterparts on nine of 11 key indicators, including rates of antipsychotic drug use and residents’ deterioration. In some cases, the internal documents show, the VA ratings were only slightly worse. In others, such as the number of residents who are in pain, the VA nursing homes scored dramatically worse.

Nick Bonanno, whose father, Russ, is a resident of the Bedford VA nursing home, said he believes the agency has withheld the information from the public to hide subpar care.

“It’s more than disturbing,” said Bonanno, who believes his father was one of many veterans overmedicated at the VA. “But it is consistent with what appears to be an ingrained culture (top to bottom) of not being accountable, and instead they hit the 'easy' button and cry 'fake news' and make excuses to justify poor results.”

Jones, the Alabama senator, accused the administration of playing “hide the ball” with the data and using the “fake news" label as a "fallback.”

“We’ve got to have the information," he said. "I’m just not going to take their word for it at this point.”