On August 24, 2012, the Department of Health and Human Services conducted a standard survey, or inspection, of the Delaware Veteran’s Home, located on Airport Road in Milford. The facility, which is the only state veteran’s home in Delaware, opened in June 2007. The survey found several areas where the home was not in “substantial compliance with the participation requirements.”
A review of the inspection shows that some of the violations were relatively minor, including failure to post statements regarding the resident’s right to file complaints, failure to provide effective pest control programs, a few hand washing errors and several documentation requirement failures. The most serious allegation, according to the state, was “failure to ensure that the resident environment remain as free as accident hazards as possible; and each resident receives adequate supervision and assistance devices to prevent accidents.”
In the incident in question, a resident sustained injury when the facility failed to secure his legs or ensure he had proper footwear when he placing him in a standard lift device when being transferred from a bed to a wheelchair. The patient suffered fractures of the left third, fourth and fifth toes as a result of the failure. In the survey, the facility responded that staff received inservice training on standard operating procedures regarding safety measures for the standard lift devices, and that additional training was provided after the incident.
Because of this violation, the state penalized the facility with a fine of $1700, later reduced to $1105. In addition, the state denied Medicare and Medicaid payments for new patients, effective November 24, 2012. This denial would remain in effect until a revisit determined that the facility regained compliance.
A revisit conducted on November 20, 2012 found no further incidences of injuries of this nature, and the facility was determined to be in compliance. On January 8, 2013, the state lifted the denial of Medicaid payments for new admissions, noting that the denial was in effect from November 24 through December 27, 2012.
According to Bill Peterson, Director of the facility, survey violations are common for long-term care homes.
“There is always something,” Peterson said. “No institute is perfect, and anytime there is something outside of the norm, it results in an issue.” Peterson went on to explain that one single item, such as the injury to the patient noted in the November survey for his facility, where an employee fails to follow standard operation procedures could result in sanctions from the state.
“What they look at is the same for every long-term care facility in the state,” explained Patty Hildebrand, Director of Nursing for the facility. She and Peterson explained further that the state grades on the scope and severity of the violation, and that the grading system includes ten levels and three tiers.
In response to the issue that resulted in the penalty and payment denials, Hildebrand said that they are dealing with an aging population where gait is a problem.
“We cannot force them to be immobile,” she explained. “Even we as able-bodied people do things we shouldn’t do, and the men in this facility are no different. Many of them think ‘I can do this, I don’t have to call the nurse” and that is something we cannot control.” In addition to mobility problems, staff must also deal with patients suffering from dementia and Alzheimer’s disease, which affect decision making.
Peterson and Hildebrand both stated that the facility uses the surveys to do a better job of caring for the patients. Administrators review any violations and revise policies to be sure they do not reoccur. This is not the first time the home has had inspection issues. Prior to the arrival of Peterson, more than 20 deficiencies were found during a routine inspection that included below average care of the veterans housed there, resulting in the resignation of Peterson’s predecessor, Dean C. Reid. Since taking over the position, Peterson said he receives very few complaints from residents or family members.
“Most of the letters I get are from family members thanking us for taking such good care of their loved one, or praising one or more of our staff for the work that they do,” Peterson said.
Peterson has been Director at the facility since March 2010 and Hildebrand came to the facility in June of that same year. Governor Ruth Ann Minner signed HB396 into law on April 29, 2004, appropriating funding to build the facility, which was dedicated on December 7, 2006. The home features state-of-the-art design and equipment, and includes a 30-bed dementia unit.