An Arkansas state-run nursing home for veterans has been rated among the worst long-term-care facilities in the state by the federal government, which gave the home the lowest possible quality rating.
The Centers for Medicare and Medicaid Services gave the Veterans Home at North Little Rock a one-star rating after several inspections that resulted in citations.
The North Little Rock facility is one of 56 one-star homes in Arkansas. There are 230 federally regulated nursing homes in Arkansas; 35 of them received five stars -- the highest possible rating.
The poor rating is the latest snag for the home, which has hit difficulties at every turn. When the state-of-art facility opened in 2017, hopes and expectations were high among state leaders and the veteran community.
But opening the specialized facility from scratch proved to be more expensive than state officials projected, and the Arkansas Department of Veterans Affairs has struggled to hire enough staff members to work at the home, exacerbating the financial burden.
Now, agency leaders are hopeful that the facility has turned a corner. They have restructured the staffing model and begun to admit more residents to chip away at the home's $120,000-a-month deficit.
"The rating is a snapshot in time," said Scott Hardin, a spokesman for the state Department of Finance and Administration, in an email. "One negative finding on a health assessment remains for three years and carries the heaviest weight. The Home may receive no deficiencies in any category for two years but until the negative assessment falls off, the overall rating remains low."
The facility is one of two state-run veterans homes in Arkansas. The Veterans Home in Fayetteville recently saw its rating decrease to three stars after regulators found several deficiencies . It was a five-star facility at one time.
The homes provide around-the-clock care to veterans and eligible dependents. The Fayetteville home is a traditional nursing home and is housed in an old hospital wing.
The North Little Rock home was the first veterans home in the state built from the ground up for the sole purpose of serving former military members. The 96-bed facility is sprawled across the former grounds of Emerald Park Golf Course.
It employs a "small-home design," consisting of eight, 12-resident cottages where veterans live. The "small-home" approach seeks to minimize the institutionalized feel of traditional nursing homes.
The North Little Rock home has been slow to fill its beds in the two years since opening for a variety of reasons, but the count reached 84 last week.
Hardin said the monthly financial deficit will continue to shrink as more residents move in, and the agency hopes that once there are 92-94 residents, the home will no longer operate at a financial loss.
The Centers for Medicare and Medicaid Services provides nursing-home ratings as a resource to prospective residents and their families. The ratings are based on facilities' performances on their most recent surveys.
The ratings take into account health inspections, staffing and quality of care. Like Hardin, the federal agency cautions that a facility's star rating is simply a "snapshot," and other factors should be considered.
The North Little Rock home was cited nine times during its annual inspection last year. Facilities in Arkansas are cited an average of 7.5 times during annual surveys.
The North Little Rock home also has received citations because of three complaints that resulted in additional surveys, and one citation stemming from a self-reported violation.
The most serious violations were discovered in January when state inspectors concluded that the home's lax reporting and investigation procedures put residents in immediate jeopardy of serious injury, harm, impairment or death. Those deficiencies stemmed from reported incidents of verbal and possible physical abuse of a resident by an employee.
The incident that led to those findings occurred weeks after the home's administrator, Lindsey Clyburn, was asked to resign. Records and correspondence obtained by the Arkansas Democrat-Gazette since Clyburn's ouster reveal the turmoil and problems that have plagued the home over the past year.
Internal state Veterans Affairs emails show that Clyburn and Deputy Director Chris Tafner of the department have had a strained relationship since Tafner was hired on a temporary basis in March 2018.
The two repeatedly butted heads over how to handle problems that arose at the Veterans Home. Clyburn said he felt that Tafner didn't have the background in health care to make some decisions at the facility, and Tafner said that Clyburn stood in the way of changes that would help the home operate sustainably.
In complaints about Tafner to top state officials, Clyburn said that stress from work had driven the home's former director of nursing to drink on the job. He said that staff members walk "on eggshells" around Tafner because he bullied and demeaned employees.
Tafner, in a letter shortly before Clyburn was asked to resign, said that Clyburn had mismanaged the facility and failed to sustain process changes that would improve the home's financial standing.
The letter stated that alcohol use was rampant among residents, and that some veterans were allowed to live in filthy rooms.
In an interview with the Arkansas Democrat-Gazette, Clyburn disputed the claims that were in the letter.
"I think it's a complete fabrication," he said. "It's one person's opinion on a lot of things who didn't have all the facts."
The Veterans Affairs Department didn't make Tafner available for an interview, but a statement from Hardin addressed some of the complaints from Clyburn and former home employees .
"As any leader implements significant changes and improvements, this will be embraced by some and questioned by others within the organization," Hardin said in the statement. "It is possible the decisions that were made in an effort to improve the Home may have been interpreted as hostile by those impacted."
Tafner is no longer working at the North Little Rock home, but instead is working out of the Finance Department -- though he remains a Veterans Affairs Department employee -- where he analyzes data from the two veterans homes. That role is temporary, Hardin said.
The home hired David Barker as its new administrator in March. Barker, who has a background in long-term care, will be paid an annual salary of $126,048.
The agency also has hired a new director of nursing, a social worker and an activities director, all with experience working in nursing homes.
"Additionally, an advanced practice nurse was hired and will remain on campus Monday to Friday to address immediate clinical needs," Hardin said in an email. "This will reduce unnecessary ER visits along with transfers and rehospitalizations, a major focus for [the Centers for Medicare and Medicaid Services]."
The North Little Rock home still has vacancies in seven of its 17 licensed practical nurse positions and two of its eight registered nurse positions.
SundayMonday on 04/28/2019