Budget woes are far from over at the Vermont Veterans’ Home.
The Bennington-based facility, which provides nursing home services for veterans, has an ongoing operating deficit of $2 million this year. Last week the Shumlin administration asked lawmakers on the powerful Joint Fiscal Committee to make up that difference in a budget adjustment after the Legislature already ponied up $1.5 million this year to help the home cover the shortfall.
The $3.5 million annual shortfall at the Vermont Veterans’ Home is in the foreground at the moment. Looming in the background is the specter of much deeper federal cuts.
The Centers for Medicare and Medicaid Services has set a termination date for Medicaid funding of Aug. 26 if the home can’t remedy standard of care problems at the facility. Inspectors for CMS will be conducting an unannounced survey of the facility in the intervening period.
A loss of Medicaid funding would cost the state roughly $7.1 million a year more, according to Jim Reardon, the commissioner of the Department of Finance and Management. CMS first threatened to pull support last fall for alleged violations ranging from insufficient staffing and mistreatment, abuse and neglect of patients, to failure to provide a safe, sanitary and comfortable environment. Shortly after CMS began an investigation last September, a nurse punched a patient.
The current enforcement cycle has “nothing to do with that at all,” according to Melissa Jackson, the director of the home. CMS most recently cited the facility for expired medication on nursing carts, she said. The federal regulators have also want to see better supervision of patients with dementia. The Vermont Veterans’ Home has one of the best-regarded dementia units in the country.
Jeb Spaulding, secretary of the Agency of Administration, told lawmakers that the administrators and staff are working hard to satisfy CMS standards and training requirements. There is “reason for optimism,” he says.
The daily census for the facility, which has a maximum capacity of 171 patients, has dropped to just 112 last year. Fewer patients means less revenue for the home from private payers and the federal government. Forty percent of the home’s patients are eligible for Medicaid.
The current patient census is 127, and about 240 people work at the facility. The annual operating cost for the home is $21 million.
Other states have managed to make their nursing homes for veterans not only solvent, but profitable.
Spaulding hopes the Bennington home, which is near the state border, will attract some of the 450 veterans who are on a waiting list for Massachusetts facilities. The governor’s office is working with Sen. Bernie Sanders to pursue a licensing agreement that would make it possible for the Vermont Veterans Home to take Medicaid patients from Massachusetts, he said.
“The governor wants to do what we can to make the veterans home sustainable,” Spaulding said.
The Legislature authorized an independent study of the management practices and costs associated with the Bennington home, the results of which should be available later this summer.
The employees of the home are state workers. Personnel makes up 80 percent of the costs associated with operating the facility.
CORRECTION: This article originally stated that the CMS investigation of the Vermont Veterans Home began after a nurse punched a patient. The probe began before that incident.