Countless media reports have looked at the devastating effects of COVID-19 in private and public nursing homes since the start of the pandemic. However, it can be more challenging to find out how our nation’s veterans have fared: some VA nursing homes are overseen by the federal government, others are run by individual states. As Politico’s executive health care editor, Joanne Kenen writes in this “How we did it,” as more horror stories bubbled up to the surface, it was time to take a closer look. She pulled a team together for a deeper dive into how these veterans’ homes had failed those who had risked it all for our country.
In all my years covering health care, with a significant amount focused on aging — I had never heard of a state veterans homes (SVHs) — basically, nursing homes for veterans.
During the pandemic, I began seeing tweets about high death tolls in these homes (and some good local journalism on them). I got curious and reached out to three Politico colleagues, Allan Vestal, a data reporter with experience investigating nursing homes, Darius Tahir, who covers aspects of the veteran affairs (VA) and our enterprise editor Peter Canellos.
Six months later we produced a 6000-word-plus report documenting how these homes had failed aging veterans who had put their lives on the line for our country. As we wrote, “Soldiers who’d survived battles couldn’t survive the pandemic, as viruses spread through many VA homes that lacked proper controls.”
Lessons learned, plus key findings
I’m going to walk you through some of what we learned and the resources we used to do this project. Oversight, regulation and performance vary from state to state, but you can adapt these lessons and tools to do some very worthwhile accountability reporting in your own state or community.
A few days after we published, Sen. Chuck Grassley, citing our work and that of some local reporters, asked the VA for some answers. Some U.S. House members are also considering offering legislation. Changes are afoot in some state legislatures as well.
Here are our key findings — which can guide your reporting as you adapt them to your state or community:
- Special nursing homes for veterans are financed by the VA but operated by the states. No one is fully in charge. “The result,” we concluded, “is a peculiar state-federal structure that creates serious gaps in accountability and makes it easier to point fingers than accept responsibility for the veterans who age and die there. The shared oversight between the states, federal government and contractors allows serious problems to fester, such as a persistent pattern of delayed maintenance in homes that were built decades, or in some cases more than a century ago.”
- The death toll in SVHs was far higher than in the VA’s community living centers — which are run fully by the VA, without division of labor and responsibility with the states. Allan’s data analysis found that state homes serve a little more than twice as many people as the federally run community centers, but their pandemic-related deaths were almost five times higher.
- Not all states require SVHs to meet the same standards as other long-term care facilities.
- Some states hire outside companies to run SVHs with mixed outcomes.
- The VA does one annual inspection, conducted by an outside contractor. Until very recently, not all the problems were flagged as deficiencies requiring a fix. Some of them were just “suggestions.”
- The U.S. Government Accountability Office (GAO) and other watchdogs had pointed out the regulatory and oversight gaps for years.
- The Centers for Medicare and Medicaid Services (CMS) oversees some homes and makes some data public. But not all state veteran homes take Medicare and Medicaid, so they don’t get this oversight or any transparency and public reporting that comes with CMS involvement.
- Some homes were built decades ago, and neither the VA nor Congress nor the states had until recently begun emphasizing renovation or replacement. The old homes had a hard time with the kind of infection control required to fight COVID.
- There were disasters in both red and blue states (although the data gaps — the 47 homes where we couldn’t find reliable publicly reported data are predominantly but not entirely in conservative states)
- Administrators of these homes, which are political appointments, aren’t always required to have a background in long-term care, geriatrics or even health care.
- Congress over the past year has significantly boosted finances for the homes —addressing those outdated physical plants and some of the extra pandemic-related expenses. But it has not yet addressed the fundamental regulatory gaps — what former Sec. David Shulkin called a “hodgepodge.”
Resources we used to get the story
CMS includes the homes it oversees on the national Covid-19 Nursing home data. Allan built a database where we tracked infection and deaths and other characteristics of the homes.
GAO reports, some of which include data we used to draw comparisons between the state homes and the VA run CLCs. (Here’s one key recent one)
Local media reports helped us gauge problems, select which states to highlight and identify local sources in the community or state government. (In some states, we couldn’t find more than a few short news stories — and often from early 2020.)
Congressional hearings and transcripts. This one from a July 2020 House Veterans Affairs Committee hearing was probably the single most useful.
Interviews with lawmakers and Congressional staff, both on record and background. (Some state lawmakers have been on top of this issue.)
VA advocacy groups (national spokesmen and state chapters) helped us find some relatives of deceased vets to interview including, the Vietnam Vets of America, Iraq and Afghanistan Veterans of America, or IAVA, and the American Legion.
The VA’s press office answered questions via email, but as we noted in the story, they did not engage in conversation with us, which would have been more fruitful and detailed. Nor did they comply with our request to give Allan a chance to discuss his data analysis with their experts. Both Darius and I had other sources within the VA who spoke to us on background.
We should note that Secretary Denis McDonough did respond to Darius’s questions at a news conference, and both former VA Secretaries Shulkin and Robert Wilkie did on the record interviews.
Every state has its own veteran’s agency — we contacted a few of them; some of them in turn referred us to the state health department.
Things to keep in mind
Every state and home is different. With the available data, it’s hard to calculate infection and death rates. The homes’ capacity is measured per bed — but more than one veteran can occupy that bed each year, given that residents may leave or die (and during the peak of COVID in nursing homes prior to vaccination, new residents didn’t always come in to fill the vacancies.) Sometimes it can look like more than 100% of residents got sick! You need to explain that — and the limitations of the available data.
Many “regular” or civilian non-vet homes had high COVID deaths too — we included some data on that. But be careful about making comparisons — it’s not always apples to apples. The patient populations aren’t identical, for one thing, either in terms of the racial and ethnic makeup, or in how sick they are and what conditions they had. A subgroup of the SVHs is more like assisted living than a nursing home; some of the state veteran nursing homes had an assisted living section. Some states have started reforms or begun a re-evaluation of their use of private contractors.
Local coverage
This isn’t a definitive list of strong local coverage, but they are good examples.
- Lindy Washburn, a health care reporter for the USA Today Network, northjersey.com & The Record, was on this story early and consistently. She covered both the early outbreaks and how the state responded. She did a bunch of stories. Google her work and check out some reporting ideas in this tip sheet.
- Maggie Severns, then our colleague at Politico, did a good piece on the California homes which overall performed well. So, if a state official tells you they did the best they could under the circumstances – press them.
- The Boston Globe has tracked the saga at the Holyoke home. Here’s their take-aways piece, and a takeout focusing on the lack of qualifications, political connections and poor performance of the director. (The systemic problems we identified also played a role.)
- A collaboration between the Texas Tribune (Shannon Najmabadi and Carla Astudillo) and the Houston Chronicle (Jay Root.) looked at the role of private contractors who run the homes.
