Patients in VA nursing homes are suffering — Wilkie needs to take responsibility

According to Richard Mollot, the executive director of the Long Term Community Care Coalition, bedsores, a condition that results from being in the same position for too long, are “almost always preventable and quickly treatable . . . so there’s just no excuse.”

So, when veterans at VA nursing homes were recently discovered to be suffering from a plethora of preventable problems, such as bedsores, what did VA do?

{mosads}They provided an excuse, of course. The excuse provided in this instance involved deflection, a common theme in VA-issued responses to criticism of VA health care. 

Specifically, in this instance, when asked about the issues related to VA’s nursing home care, Secretary Robert Wilkie responded that VA’s nursing homes “care[ ] for sicker and more complex patients in its nursing homes than do private facilities.”

Unfortunately for VA, this response simply doesn’t add up.

Although Wilkie is correct that VA does in fact deal with patients with poorer health status than the general population, the issues highlighted in the recent nursing home reports are easily preventable and are not complex problems.

Therefore, blaming VA’s nursing home care-related errors on the health-care status of its residents is at best, misguided, and at worst, dishonest.  

Wilkie’s response is also a good reminder that, at the time of his Senate-confirmation vote, Sen. Johnny Isakson (R-Ga.), chairman of the Senate Veterans’ Affairs Committee, told Wilkie: “You have no excuses. We’re here to make sure VA has no excuses, only results.”

It is therefore time for Wilkie to live up to his exchange with Isakson. Rather than continue to issue excuses in the face of adversity, it’s time for VA to try something new: implementing a culture of personal responsibility amongst its leadership. Only then can VA achieve Isakson’s goal of results rather than excuses.

By way of background, earlier this week, VA released a series of inspection reports detailing deficiencies in 52 out of 99 nursing home care facilities that caused “actual harm” to veterans. 

For example, as highlighted by USA Today, veterans moaned in pain due to lack of adequate medication at VA nursing homes in Dayton, Ohio and Augusta, Maine. Inspectors found that VA staff failed to prevent or adequately treat bedsores at several facilities. And, VA staff often failed to take steps to prevent and control infections, such as failing to wear sterile gowns or gloves when treating residents.

Despite the Trump administration’s frequent refrain that VA is now providing unprecedented transparency and accountability to stakeholders, Wilkie’s attempt to deflect from VA’s nursing home problems with emphasis on unrelated comparisons shows that the agency still has a long way to go, because it still lacks a core-culture of personal responsibility.

Although VA has improved its level of transparency, as evidenced by the release of these reports (albeit nine months later), it can still improve its accountability by accepting responsibility for the problems outlined in them rather than making excuses and deflecting.

When broken down into its basic components, the word “responsibility” becomes ‘”response” and “ability.” In other words, VA leaders have the ability to choose how they will respond to reports that find problems in a manner that emphasizes responsibility and ways it will address the problems over excuses, or not.

VA’s past history of making excuses is well-documented, and we must acknowledge that, from a systemic perspective, transforming its culture of excuses to one of personal responsibility is no easy task.

For example, in the wake of the 2014 patient wait-time scandal, VA Deputy Secretary Sloan Gibson suggested that media coverage of the issue was “crap” rather than a real issue that needed to be addressed.  

Similarly, in the wake of a problem concerning GI Bill payments last fall, VA’s Office of Information Technology and Benefits Administrations simply pointed fingers at each other, leading Senator Corey Gardner (R-Colo.) to state that “figures at VA appear more adept at playing the blame game than taking responsibility” and solving problems.

Moreover, we, as stakeholders, must stop confusing responsibility with blame. When VA does take responsibility for an issue, the most common media response is to search for someone to blame. It is important in this regard to realize that there is seldom one person to blame for systemic problems. Therefore, just because someone is stepping up to take responsibility, it does not mean that they are solely to blame.

If we want to foster a culture of personal responsibility within VA, stakeholders must also agree to stop playing “the blame game” referenced by Gardner, and transition from blame to solution-oriented responses.

Here, with regard to the nursing home reports, if Wilkie had responded to the release by acknowledging that preventable problems were found, and outlined tangible steps VA would take toward improving those problems, rather than deflecting through a non-applicable comparison, he would have succeeded in not only taking personal responsibility for the problem, but also in taking a much-needed step toward improving VA culture, department-wide.  

A culture of responsibility is a greater asset to an organization like VA than the things we most often hear about, such as an increased budgets or legislative changes. As recently outlined by Robert Greczyn, Jr., the Chairman and CEO of Blue Cross and Blue Shield of North Carolina, a culture of responsibility means “having a clear commitment to ethics and compliance with rules, laws and regulations,” as well as “having a well-defined mechanism for employees to report any concerns they have.”

Last summer, Wilkie confirmed that he was ready to lead VA without excuses. Unfortunately, as outlined by his deflection-based response to the problems with VA’s nursing home care, so far, he’s failed.

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.