07/25/2008

By SHANNON DININNY  / Associated Press

The U.S. Department of Veterans Affairs has shut down its 30-bed nursing home in Walla Walla after an outside review raised concerns about the quality of care, and an internal audit validated those concerns.

Just 10 nursing beds were occupied.

The Long Term Care Institute was contracted by the VA nationally to review nursing homes around the country. The unannounced, though not unexpected, inspection at the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center on July 15 raised immediate concerns about the physical infrastructure of the nursing building, which is about 80 years old. Concerns included sloping floors and patients' access to doors and stairwells.

The review also raised concerns about administrative control of medication and the competence of nursing staff inserting intravenous catheter lines.

VA officials began notifying patients and their families Wednesday night that the center would close. Two patients already had been scheduled to be discharged, and social workers were hoping to place the remaining eight patients in new facilities by the end of the day Friday, said DeAnn Dietrich, acting medical center director.

"We had to do the right thing for patients, and if we can't provide care that is equal to or better than the private sector, we shouldn't be doing it. So we had to shut it down," Dietrich said.

Established in 1858 on an 84-acre campus at Fort Walla Walla, the Jonathan M. Wainwright Memorial VA Medical Center serves an estimated 69,000 veterans in southeastern Washington, northeastern Oregon and northern Idaho. The center has 66 beds for acute care, nursing, psychiatric and substance abuse treatment. Thirty beds are devoted to nursing.

The medical center has been threatened with closure for several years as part of an overhaul of the VA's health care system, but local and state officials and lawmakers from all three states have fought to keep it open.

The nursing home has averaged 21 patients daily since Oct. 1, but it stopped accepting new patients after the first reviews last week.

Inspectors raised concerns about patients' access to doors and stairwells at the end of long, blind corridors, as well as the aging building's sloping floors and narrow doors and hallways.

Nursing staff who inserted catheter lines to administer medication also were not up to professional competency, the review found. Concerns also were raised about administrative control of medication, particularly narcotics.

"While the building is seismically up to code, it's not adequate and it doesn't meet anyone's idea of what a long-term care facility should look like," Dietrich said. "We also realized the clinical competency issues weren't isolated. We did have staff doing some good work, but we didn't have a good system for ongoing training, documentation."

The medical center has a plan in place to address the immediate concerns and is conducting a feasibility study of the nursing home to determine if it should be reopened, she said.

Two years ago, the VA announced plans to build a $94 million outpatient clinic in Walla Walla to serve veterans. That project is not among the top 10 on the department's priority list for construction nationally and was not included in President Bush's proposed 2009 budget.

The state office of veterans' affairs also has been considering construction of a state nursing home at the campus, but that is likely several years away.

In the meantime, 10 temporary staffers at the nursing home were given two-week notices, but the medical center is trying to help them find other jobs. Thirty full-time staffers will be kept on in other positions at the campus, Dietrich said.

Staff and patients are all sad about the decision, she said.

"It's not an easy transition, to move from one community living center to the next. It's not a decision we took lightly," she said. "It's disruptive, and we're trying to do the best we can, but the overriding reason is that we all felt we had to ensure the patients were in a safe environment."