For months, the VA has insisted it had no legal obligation to give a home-by-home breakdown on death and infection — although nothing had stopped the agency from doing so voluntarily, as some states have done. It changed that policy on Thursday.
Citing pressure from Congress, the VA said on its website that state homes will have to report “COVID-19 related information” to both the VA and the CDC, and the veterans agency will in turn start making it publicly available week by week.
“VA is now providing a downloadable spreadsheet with reports for individual SHs,” the agency said in its statement. “VA is also displaying a graph showing trends for cases and deaths among residents and staff.”
The Centers for Medicare and Medicaid Services oversees most but not all of the homes. It had declined to publicly report the data for the homes not under its purview. Homes that were more like assisted living centers than full-fledged nursing homes don’t receive CMS oversight, and those Covid counts remain sparse in the first batch of data in the VA’s new public spreadsheets. Many currently report zero deaths but the VA stressed the numbers are still being submitted and reviewed so the charts will be updated.
However, some of those assisted living facilities may continue to show few or no deaths as they — and their civilian counterparts — were not required to report their numbers until February 2021, a VA spokesperson explained. By that time, cases were dropping in long-term care settings as vaccinations were available. They didn’t have to report earlier cases from 2020.
“We saw far too many unacceptable deaths during the COVID-19 pandemic across State Veterans Homes and VA needs to be held accountable for overseeing veterans’ quality of care at these state-run facilities,” Senate Veterans’ Affairs Committee Chair Jon Tester (D-Mont.) said in a statement. “That’s why my colleagues and I pushed VA to provide public-facing data on State Veterans Homes that will increase transparency and align them with nursing home safety standards — ensuring they do their part in protecting the men and women who served our country.”
In August, POLITICO published a five-month investigation into the flawed oversight, high case loads and lack of transparency in these state veterans homes. Specifically dedicated to caring for elderly U.S. veterans, the homes — which are financed under the VA, but run by state governments or the contractors they hired — suffered from a lack of oversight, with the states and federal government blaming the other for any lapses.
The result was disastrous, according to partial data assembled by POLITICO, which showed a far higher per capita death rate at the state homes compared to similar facilities operated by the VA itself. But at least 46 of the 158 state veterans homes did not provide any data, making the true extent of the pandemic toll unavailable. Neither families of residents who died in the homes nor vets advocacy groups nor the media could really know what was going on inside the homes.
Since late summer, POLITICO has reached out, often repeatedly, to all of those homes that were missing from the CMS nursing home website. Some willingly released data about infection and deaths; others simply ignored the questions and requests. Many of the data holdouts were in states particularly hard-hit by the Delta wave last summer, like Alabama, Mississippi and Missouri.
Data from some of those homes was still missing from the spreadsheet on the VA website as of Friday, but the VA said it was working on verifying state data and plugging gaps.
Lawmakers on both the House and Senate veterans’ affairs committees had prodded the VA to release the data. As part of a huge appropriations package in late 2020, Congress had included language mandating VA disclosure. But the VA had until now insisted the precise wording of that measure only required national tallies, not home-by-home reports. Hill staff said the intent was clear, and that they had been talking to the VA about a fuller response.
Under pressure, the VA changed its mind. The data appeared on the VA website Thursday. It also includes data on vaccination rates in state veterans homes.
The black hole of data has been part of a larger problem of oversight and accountability of these homes. Growing out of the need to house aging veterans of the Civil War, the state homes have long served and honored the country’s veterans in their final days. While states embraced the need to care for veterans, the federal VA gradually took over the funding. Yet it required only one annual inspection to make sure homes were following proper health and safety procedures, and inspectors lacked the power to order changes. Some states notably declined to force the veterans homes to follow procedures required of private nursing homes. Some also did not require top officials overseeing the homes to have experience in health care or serving elderly residents.
Thus, when Covid-19 first struck in early 2020, some homes in states with vigilant oversight, such as California, did reasonably well. Many other homes had devastating outbreaks.
Following POLITICO’s report over the summer, Sen. Chuck Grassley (R-Iowa) on Aug. 30 demanded that the Department of Veterans Affairs address questions about the quality of care, infection control and oversight.
“The VA regularly provides well over $1 billion annually to State Veterans Homes, to cover all or part of the care for veterans in need,” Grassley wrote to VA Secretary Denis McDonough. “I strongly question the adequacy of the VA’s oversight of this federal spending.”
“Our veterans deserve the best possible care after giving so much for our country,” Grassley said in a statement at the time. “Unfortunately, it appears that the standard of care and quality controls at many state veterans homes falls well short of those required by other government supported nursing homes.
To some advocates for veterans, the VA’s lack of transparency has been frustrating but not surprising. Linda Schwartz, a former state and federal VA official, tried to write a report with the Vietnam Veterans of America on the performance of states homes during the pandemic last year.
“We thought this was going to be an easy thing to do, but it wasn’t,” she said. “VA has a wake-up call. They were thinking everything’s hunky-dory out there — and it’s not.”
Joanne Kenen is the Commonwealth Fund Journalist in Residence at the Johns Hopkins School of Public Health.