Why the covid death toll was so high at some veterans homes
How Charlotte Hall in Maryland, like other veterans facilities across the country, was devastated by the pandemicIt was almost Memorial Day, and retired Army Sgt. Bill Meck was thinking about the dead. It had been nearly a year since covid-19 had hollowed out Charlotte Hall Veterans Home — the state-run facility for veterans and their spouses where he lived. Before the pandemic, he could usually expect to honor a resident who had recently died. Taps would be played.
Charlotte Hall was not alone in its struggles. Across the country, state veterans homes were among the most dangerous long-term-care facilities during the pandemic. More than 145 veterans died in two homes in New Jersey. One hundred and twenty-one at a New York home. Dozens more in Hawaii, Illinois and Oklahoma. Seventy-six veterans died in one Massachusetts facility, where two officials wereThe death toll raised urgent questions about what is owed to these veterans now and in the future.
The first state veterans homes opened in the wake of the Civil War, when the ranks of disabled veterans soared. The homes were a manifestation of Abraham Lincoln’s pledge in his second inaugural address “to care for him who shall have borne the battle,” a quote that is enshrined on a plaque at VA headquarters in Washington.
Bill was honorably discharged, and he spent months in rehab at a VA hospital in Richmond, learning how to live as a quadriplegic. Later, he stayed in the area and got a job working for the city as a computer programmer. He married, but the marriage didn’t last. Patty wanted to move him back to Maryland, to be closer to family, and he agreed.
On March 11, 2020, according to an internal memo, Charlotte Hall suspended visitation, except in end-of-life cases. But even as the home barred loved ones and nonessential visitors, residents in its assisted-living program — who live more independently than its nursing home residents — were allowed to come and go from the campus, creating another point of entry for the virus.
It’s a key part of infection control to move sick residents into a separate wing, according to Charlene Harrington, a nursing-home expert and professor emerita at the University of California at San Francisco’s nursing school. “That’s common sense.” A delay can be “the kiss of death,” she says. “Once you have one patient, it can just spread.”
Like in most facilities early in the pandemic, personal protective equipment was in short supply, though Brewster says the veterans home never ran out. Gowns were particularly scarce. Ad hoc supply chains sprung up. Volunteers delivered face shields to the facility. HMR contracted a hockey-jersey manufacturer to make reusable gowns.
Alex Kavounis’s father, Al, lived on a dementia unit. The 92-year-old was confined to his room after the outbreak. According to Kavounis, the World War II vet, a rule-follower to the end, would yell out his door if he could see fellow residents wandering in the hallway, telling them to stay in their rooms. On May 13, he died of covid.
For weeks, Bill’s unit had been spared from the virus. The building’s main dining room was closed, but Bill says his unit, 3C, had its own dining area, where the staff still served residents communal meals. He chose to stay in his room. Many rooms at Charlotte Hall were shared, and between most rooms was a shared bathroom. Bill said he spoke to a supervisor about residents who weren’t social distancing. “Well, we can’t make them stay in their room” was the reply.
“If they did such a good job, how come so many of my buddies are dead?” asks Charlotte Hall resident Bill Meck. One of those losses was Cy “Tike” Butler, an 81-year-old Navy veteran with Alzheimer’s. In late May, his family got a call that someone he shared a bathroom with had covid, and then a few days later, he had it. He was eventually sent to the hospital, where his daughter Sandi Junge held the phone so her high-risk mother could talk to him before he died. “They just had the love story,” she told me later. Married 55 years and still holding hands.
In better times, he loved taking his wheelchair out on the trails that surround the home. An avid photographer, he would snap nature pictures with a camera mounted to his chair. One of his favorites showed the vanishing point of a horizon, where it appeared as though the trail went on as far as the eye could see. By comparison, his room and world were now very small. He watched a lot of movies and television to pass the time, but there was only so much to stream.
Retired Marine Lt. Col. Philip Forbes, who served in Vietnam, says the staff has “taken real good care of me,” but it didn’t make the isolation easier. “You get very frustrated,” he says. He missed dinners with his wife, smelling the grass outside, getting to Mass on Sundays. “Thank God for news channels,” he says, “or we could be on the moon when they lock you down.”
They got a few responses, including some emails that confirmed receipt. The governor’s office sent a form response about covid protocols. Bill was touched when state Del. Benjamin Brooks from Baltimore County, himself a Vietnam veteran, spent nearly two hours on the phone with him on July 3. He listened to Bill’s complaints on everything from the food at Charlotte Hall to low morale because of covid. Brooks reached out to Owings and Murphy.
Sen. Chris Van Hollen’s office flagged Bill’s essay for the Maryland Department of Health, which then reached out to Bill. It would take almost 10 months before anyone investigated his concerns. Inspectors arrived at Charlotte Hall on April 5, 2021, to investigate 26 complaints, according to records from the Centers for Medicare & Medicaid Services , which is part of the Department of Health and Human Services.
On the one hand, there were compassionate acts by so many of the staff who risked their own lives, and on the other hand, the entire long-term-care system seemed broken. “The system failed them,” Junge says. “Because the workers, they were crushed. They had to watch these people that they care for lose their lives.” Junge couldn’t understand why it wasn’t a bigger deal that dozens of veterans at Charlotte Hall had died. Vicki Bromble didn’t blame the nurses either.
Charlotte Hall’s staffing ratio for registered nurses is low, according to CMS data. “Their staffing rating isn’t bad,” Harrington told me, “but their RN staffing rating is very bad.” On average, according to CMS, the home’s registered nurses spend only 37 minutes per day with each resident who requires nursing care. The statewide average is 58 minutes. Harrington says the minimum should be at least 45 minutes, and more with acute residents.
And yet, for some families, an HMR facility like Charlotte Hall was still the logical choice. “It was our only option,” Kavounis says. His family couldn’t afford other facilities for his father’s dementia care. With his father’s combined benefits, he says, they paid nearly nothing out-of-pocket at Charlotte Hall.
Some leaders of state veterans homes argue they have been unfairly blamed during the pandemic. Melissa Jackson, who heads the Vermont Veterans’ Home, told me, “The moment this pandemic hit, we became the scapegoat, the whipping boy, whatever you want to call it for everything that went wrong with this pandemic.” Jackson is the immediate past president of the National Association of State Veterans Homes , a volunteer advocacy organization for the industry.
For all the homes, there is still the issue of VA oversight. A 2019 Government Accountability Office report found that VA inspections of state veterans homes were lax and corrections were not adequately enforced. In July 2020, the GAOthose concerns. Though most GAO recommendations have now been implemented, VA still does not post inspection data for state veterans homes on its website.
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