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‘They can’t ignore staffing issues’: Years before coronavirus outbreak, Soldiers’ Home leaders pressed state for more funding

This May 2018 file photo shows an aerial view of the Holyoke Soldiers' Home in Holyoke, Mass. The superintendent of the veteran's home was removed from his duties Monday, March 30, 2020 after several residents died, including some who had tested positive for COVID-19 and others whose results are pending. (Patrick Johnson / The Republican/TNS)

Five years ago during a public hearing at the Soldiers’ Home in Holyoke, retiring superintendent Paul Barabani said the state’s failure to respond to his repeated pleas for additional funding and staffing amounted to “deceit.”

Before an audience that included one of his bosses, state veterans affairs secretary Francisco A. Ureña, the home’s trustees, residents and their family members, Barabani put it simply: “Current staffing levels are inadequate and jeopardize patient care.”

It was a position that Ureña disputed to the same audience, saying the state and the administration of Gov. Charlie Baker had shown a “demonstration of commitment” to the Soldiers’ Home. A family member of a 97-year-old resident then looked at Ureña and said the state was engaging in “a lot of the political talk. We’re the stepchildren. We’re the forgotten few.”

Fast forward to today and the issue of insufficient staffing and its impact on care at the Soldiers’ Home is front and center as now more than a third of its veterans are dead in the midst of the outbreak of the COVID-19 coronavirus that rampaged through the home in mid-March, affecting both residents and staff.

Since then, the home’s current superintendent, Bennett W. Walsh, has been suspended, interim leadership and the National Guard brought in to provide clinical care to the remaining veterans and at least four state and federal investigations are underway to determine how the outbreak unfolded and how the response to it was handled.

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For years, Western Massachusetts legislators say they have heard time and time again about the need for increased funding for the Soldiers’ Home. They heard it at Memorial Day parades, they heard it at Veterans Day observances and they heard it at what had been an annual breakfast for lawmakers at the home.

Barabani, though, took the issue to a new level in 2015, making it clear in a very public battle with state leadership and the home’s trustees in December 2015 that he was retiring because state officials failed to boost funding, leading to staffing shortages and other deficits at the home.

“I’ve been given a mission, but I haven’t given the resources to accomplish that mission,” Barabani said at the time.

The state-run long-term care facility for aged and infirm military veterans has been devastated by COVID-19. More than 80 veterans have died since mid-March, with more than 70 testing positive for the disease. Scores more are infected in an outbreak that is reportedly the worst in any health care facility in the country.

Walsh was placed on administrative leave on March 30 and has said he is cooperating with the string of investigations that are probing what occurred when and how the response to the outbreak was handled. The allegations include poor management, a lack of communication and inadequate staffing.

State officials, including Ureña, have said they only learned about the spreading coronavirus over the weekend of March 28 after at least eight veterans had died. Mary Lou Sudders, secretary for the Executive Office of Health and Human Services, sent a team of experts to investigate the problem which found most of the veterans on one unit were suffering from COVID-19 and the disease had spread when those infected were not quarantined from others.

Val Liptak, a registered nurse who headed the state-run Western Massachusetts Hospital in Westfield, was brought in to take over leadership. A clinical team, headed by Lisa Colombo, executive vice chancellor for Commonwealth Medicine and a former hospital administrator, with experts in infectious disease, finance and operations also stepped in to try to stabilize conditions at the Soldiers’ Home.

About 160 National Guard members have also been working at the home for nearly a month to augment the staff – which was described by Liptak as already small for the number of residents – which was now overwhelmed because so many nurses and certified nursing assistants were out ill with COVID-19. Currently, 81 employees have tested positive for the disease.

Walsh, over the course of the past month, has issued statements in which he maintains he kept both Ureña’s and Sudders’ agencies aware of the unfolding outbreak, including filing a request on March 27 for assistance with staffing from the National Guard. His request for the added help was rejected, Walsh has said.

State legislators say Barabani often lobbied them for funds during his four-year tenure, as did his predecessor, Paul Morin. At the time of his exit Barabani said the only way he would stay was if a concrete plan was established to add jobs and fill positions that had long been vacant. He demanded that the trustees vote unanimously to support him and allow him to make decisions he felt were needed to properly run the facility. Even Ureña that December said those conditions would not likely be met.

It wasn’t long before there was another indicator that the staffing issue was contributing to level of care provided at the home. Between January 2014 and August 2017, the Soldiers’ Home recorded 2,074 cases of residents falling at the facility with a veteran hurt in nearly 600 of those falls, suffering bone fractures, joint dislocations and a loss of consciousness. Many of those falls were attributed to inadequate staffing, according to employees and families of residents.

An audit done by the U.S. Department of Veterans Affairs in 2018 found the home met or provisionally met all 231 standards established by the federal government for health and safety standards, although it is unclear if the audit examined staffing issues.

When the home’s trustees met for their monthly meeting on March 10, 11 days before the first veteran tested positive for COVID-19, Walsh reported that multiple precautions had been put in place to help prevent the virus from spreading. In response to a trustee’s question about contingency plans in the event staff members became ill, Walsh said the home regularly contracts with four outside staffing agencies and could bring in temporary employees if needed, according to the meeting minutes.

The need for additional staffing had not been addressed by the state, and former deputy superintendent John Paradis says it’s clear the issue will not go away without more funding.

“This will continue to happen until the state realizes they can’t ignore staffing issues at the Soldiers’ Home, among other things,” says Paradis. Retired as a lieutenant colonel in the Air Force, Paradis continues to work with veterans. He resigned in 2015 at the same time as Barabani. ”At the end of the day, I resigned because of the failure of the state Department of Veterans Services to understand the human and financial resources needed to run the Soldiers’ Home.”

Barabani has not returned calls for comment, but Paradis says his former boss took steps to make changes aimed at better management of the home, including developing what he called a triage admissions policy, instead of the first-come-first-serve standard that had been in place for years to handle the long waiting list. Its goal was to ensure those who needed care the most were accepted first. Barabani also discussed plans to build a new wing to the building that would create a more modern facility allowing veterans to have single rooms and their own bathrooms.

“We came into it with one reason – to do our very best to ensure the veterans had the best quality of life,” Paradis says.

Long-term care facilities are proving especially vulnerable to the coronavirus since they serve the elderly and infirm, some of whom are most likely to suffer severe and often fatal cases of the disease. Many of these patients have either – or both – do-not-resuscitate and do-not-hospitalize orders in place. Also, experts say the congregate nature of the facilities make it more difficult to contain the virus and keep it from spreading.

Over the past six to eight weeks, the Soldiers’ Home has come to have the highest death and infection rate of any facility in the country.

“Like a lot of people I heard about what happened on the news,” Paradis says. “It was a total and complete sense of shock to see it at a facility that is iconic in our region. Then, I had a sense of utter anger. I was angry at the state government.”

While Paradis has praise for work done by the support staff, including certified nurse assistants, food service and other workers, he says the lack of staffing always stood in the way of providing the best medical care to veterans.

The Soldiers’ Home is unusual as a long-term care facility because it is financed by the state, with about half the funding reimbursed by the federal Veterans Affairs. It is overseen by a board of trustees, the members of which are appointed by the governor, and the Department of Veterans Services, which comes under the Executive Office of Health and Human Services.

During the four years of Baribani’s leadership, Paradis says there was a consistent effort to lobby the region’s legislators for funding. Very detailed information, showing the nuts and bolts of everything including maintenance and cleaning and went as far as to figure the cost of the care of residents with different needs to the hour, was prepared to support the effort, he says.

“We felt they can’t help you if they don’t know there is a problem,” Paradis says. “We felt we need to make some fixes and impress upon them the challenges.”

As word of those lobbying efforts reached state headquarters, though, according to Paradis, Barabani was summonsed to Boston where he was reprimanded by Ureña’s predecessor, Coleman Nee.

Area legislators say the funding process for the home has evolved in recent years. State Sen. James Welch, D-West Springfield, says that in 2005, when he was first elected a state representative, the governor and secretary of health and human services would put together a budget and the then-superintendent, Paul Morin, would talk to the Western Massachusetts delegation to lobby for additional funding. At one point in 2002, the home had to lay off more than 50 workers and was prepared to close of its long-term care wing in a particularly heated budget battle.

Later, under Gov. Deval Patrick’s administration, the state would put together the budget and Barabani would assemble a separate proposal, saying “this is what we really need,” a move Welch says created friction between Boston and Holyoke.

“Now, they are more in lockstep,” Welch says. “The administration has tried to bring it under the same umbrella so they were asking for the same thing.”

While the Holyoke Soldiers’ Home budget has increased 22.8% over the past eight years, there have been a number of lean years, especially recently. In fiscal 2016, the same year Barabani left, the Soldiers’ Home saw one of the largest boosts in funding, when the budget increased by 7.8% from $21.4 to $23.1 million, state records show.

But in fiscal year 2017, Walsh’s first year as superintendent, funding was cut by 2.4% to $22.5 million. The next two years funding remained the same. In this fiscal year, which started in July, the budget increased by 5.6% to $23.8 million, records show.

The budget cut was tied to a reduction in the number of residents who were accepted in the home, according to Paradis. In Barabani’s first three years as superintendent the budget increased a total of 9.8% from $19.5 million in 2012 to $21.4 million in fiscal year 2015, state records show.

The budget for the coming year has not been submitted yet, but minutes of the trustees’ March meeting shows there is at least an initial request for a 1% increase.

“(Member) Christopher Dupont questioned why the Soldiers’ Home is asking for only a 1% increase in its annual budget for next year. Is it being mandated by the commonwealth of Massachusetts that we can only ask for 1% or is that just what the Soldiers’ Home in Holyoke does on an annual basis?” the minutes state.

No answer was given, and trustees are now referring all questions to state health and human services officials. Officials at the department have not responded to questions The Republican submitted in writing.

State Rep. Aaron Vega, D-Holyoke, says Barabani always talked to him about a lack of funding and staffing shortages and would request money for projects. Walsh, meanwhile, did not do that.

In what had been an annual tradition, area legislators were welcomed to a breakfast at the Soldiers’ Home at which they would meet with the superintendent, doctors, nursing director and other administrators to learn about funding needs. That changed when Walsh took over, with officials mostly talking about new programs and initiatives at the home, according to former state Sen. Donald Humason, who is now mayor of Westfield.

Humason says Walsh did not keep completely silent and would address issues when legislators sought him out on a one-on-one basis.

“The sense was that they could do more if they had more people. If they had more staff they could serve more veterans,” Humason says. “It would be more of an off-the-record thing. My sense was the superintendent was advised not to go against their bosses.”

Walsh declined to comment for this story through his lawyer, former Hampden County district Attorney William M. Bennett, who is also his uncle.

The state has a three-tiered administrative system for the Soldiers’ Home in which Gov. Charlie Baker is the appointing authority and decision-maker. The superintendent directly reports to veterans’ services secretary Ureña, and the home’s operations are also overseen by the Executive office of Health and Human Services.

Some observers say adding the additional level of bureaucracy was a mistake and made it more difficult for the superintendent to reach the secretary to discuss issues tied to medicine and nursing. Others question if it should instead be under the state Department of Elder Affairs, which oversees most long-term facilities.

“One of the issues (at the Soldiers’ Home) is funding, and we do realize it will be a big part of going forward,” says state Rep. John Velis, D-Westfield. A major with the Army Reserve, Velis visits the home regularly, holds office hours for constituents there and is an advocate for veterans’ needs.

Velis, like Welch, says funding requests were not made to members of the legislative delegation in recent years. “Why were we not asked? Why did no one ask us for funding?” Velis says. “There may have been extra influences, outside influences that told them not to ask.”

Velis says he’s heard now from people associated with the Soldiers’ Home that administrators were told not to raise the issue of funding to legislators.

There are now at least four investigations underway concerning the operation of the home in the midst of the pandemic, including one by an independent investigator appointed by Baker. In addition, U.S. Attorney Andrew E. Lelling, state Attorney General Martha Healey and Inspector General Glenn Cunha have initiated investgations. The House and Senate plan a separate hearing on the issue, requested by Vega, when legislators return to session.

Paradis feels the home was especially vulnerable due to the crowded conditions that had three and even four people to a room. Without changes moving forward, a crisis like this could occur again, he believes.

Velis is hopeful the investigations at all levels will reveal what has been happening at the home. “We have a national tragedy that has run afoul of everything that we care about in this nation,” he says.

Velis says he met with Liptak and other current leaders at the home, receiving an update about everything they are doing to care for the veterans. “I think they are doing everything in their power to stabilize and right the ship,” he says. “They are doing everything in their power to stop people from dying. They are doing everything in their power to stop the spread of this horrible, insidious disease.”

Velis also toured a unit at the home where about 30 residents who have tested negative are living. He says he talked with some of the residents he has gotten to know from his past visits and was surprised at how upbeat many of them were despite the tragedy they are facing.

He also praised the staff members, saying he has never heard anyone complain about the one-on-one care the veterans received, especially from the certified nursing assistants. He says he understands the toll the deaths are taking on those employees, who spend the most time with the residents and get to know them the best.

On the visit he attended a memorial service outside the building for a gentleman who lived in his district. “As they were playing Taps, I looked at all the staff nurses standing around and there was nothing but wet eyes there,” he said.

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© 2020 MassLive.com