State-mandated report addresses coronavirus issues at veterans homes

A surge of COVID-19 cases hit veterans homes across Missouri in the summer, and a state-ordered review has identified a number of actions for administrators to implement.

Brian Kaveney of Armstrong Teasdale LLP of St. Louis penned the report, recently released through Missouri Veterans Commission (www.mvc.dps.mo.gov), indicated the disease associated with coronavirus struck veterans homes later than it appeared in other areas but administrators did not aggressively develop or implement plans to combat its spread:

“MVC Headquarters failed to recognize and appreciate the impact of even one positive case of COVID-19, despite a number of experts, like the Missouri State Epidemiologist and the Missouri Medicaid Director, defining a COVID-19 outbreak in a residential setting as a single positive case. This meant that MVC leadership did not change tactics to aggressively contain the first positive cases, nor did they reach out to external partners for assistance. Instead, they treated the initial cases as something that could be overcome using the same directives, policies, and internal resources that had been employed prior to the positive case,” the report states. “MVC Headquarters demonstrated an absence of leadership in failing to appropriately plan for a severe and prolonged COVID-19 outbreak. Headquarters should have known by the beginning of summer 2020 — well before the fall outbreak — that COVID-19 spreads covertly through asymptomatic carriers and is difficult to control in a residential setting like a nursing home. But despite several months to prepare for a predicted fall surge in COVID-19 cases, MVC Headquarters did not develop any comprehensive outbreak plan. As a result, they did not have an opportunity to vet the plan with outside agencies or other long-term care facilities, or test the plan to identify areas of needed improvement. The lack of a comprehensive outbreak plan led to confusion and inefficiencies, and it almost certainly contributed to the inability to contain the spread of COVID-19 once it was introduced into the Homes.”

The report notes administrators’ initial virus response staved off infections in the veterans homes:

“The efforts by the Headquarters and the Home staff paid early dividends as evident by the fact that, with the exception of one positive veteran in St. Louis in April, no Homes reported any positive cases until the late summer. These initial positive cases in April, July and August were successfully identified and contained within each Home without causing a prolonged, facility-wide outbreak. ... Comparatively, over that same period, other long-term care facilities experienced multiple outbreaks with tragic results. For example, in the St. Louis area during this same period, long-term care facilities were reporting double digits deaths associated with acute COVID-19 outbreaks.”

Eventually, though, COVID-19 cases began to rise in veterans homes across the state. Virus cases, deaths and mortality rates in the state’s veterans homes as of mid-November:

• Cameron: 83, 34, 41%
• Cape Girardeau: 96, 29, 30%
• Mexico: 21, 2, 10%
• Mount Vernon: 41, 9, 22%
• St. James: 60, 21, 35%
• St. Louis: 15, 1, 7%
• Warrensburg: 26, 7, 27%.

Veterans Commission chairman Timothy Noonan said administrators have taken actions in response to the report.

“We are dedicated to serving our veterans, especially during these difficult times,” Noonan said in a release. “As part of the review process, the MVC received early recommendations that enabled immediate action to reduce the spread of COVID-19. The additional information learned from the investigation was insightful and will drive the reforms to be implemented by the MVC. The dedication of the Armstrong Teasdale team, which included veterans, former medical and clinical professionals and prosecutors, was unmatched. Their recommendations provide us a roadmap that will challenge the MVC and other stakeholders to address the current pandemic and implement necessary reforms.”

Among the actions taken thus far:

• expand use of data analytics
• streamline reporting
• examine structure of MVC
• implement outbreak plan
• implement COVID-19 reset
• implement Essential Caregiver plan
• implement inside visit plan
• improve communication with families.

Investigation

Investigating the virus outbreak in the veterans homes consisted of interviewing 174 people and analyzing nearly a thousand documents, the report states. The interviews addressed all aspects of the homes’ operations and virus response.

Another component involved a telephone hotline that collected information from veterans’ family members. Seventy-five people submitted reports through the hotline.

In addition to the physical consequences of COVID-19, its social and mental health repercussions were also part of the review.

The report states actions taken to limit spread of the virus affected veterans in several unintended ways:

“That is an outbreak of loneliness, isolation, depression and atrophy. The veterans are alive, but not living. This is not consistent with the mission of the Missouri Veterans Homes.

“Many veterans are becoming depressed, some have stopped talking and eating, several cry, and many have suffered significant cognitive decline due to a lack of stimulation. One veteran asked if his wife had divorced him since (he) has not seen her in more than 6 months. Another asked if his daughter had died since he had not seen her in person. ...

“Further, physical therapy, occupational therapy and speech therapy are no longer being provided in the Homes nor are exercise classes, art classes or therapy dogs. The absence of these physically and mentally stimulating activities, is contributing to the deterioration of the veterans’ conditions.”