Byline: Peggy Lowe, Rocky Mountain News
AURORA -- Patriotism was in the air, politicians were on hand and aging soldiers were treated like celebrities at the red-white-and-blue ribbon-cutting for the State Veterans Nursing Home at Fitzsimons.
It was July 3, 2002, and the $25.3 million state-of-the-art facility was set to open on 15 acres at the former Army hospital.
'This new facility is a way for Colorado to express our gratitude to our veterans when they need our help, just as they sacrificed to help our nation,' Gov. Bill Owens said.
That gratitude turned to shock only 17 months later. Federal officials, acting on reports describing conditions there as worse than at any nursing home in Colorado history, shut off admissions and forced the state in December to hire a private company to run it.
Owens, conducting a rare, surprise visit to the facility that month, was upset by what he saw and promptly hired Pinon Management Inc., which specializes in cleaning up nursing homes.
After a little more than a year of operation, what was being called a home for heroes had become the subject of horrifying reports. On the A-to-L grading system used by state health surveyors, Fitzsimons rated two L's, meaning it had pervasive problems that placed residents' health and safety in immediate jeopardy.
Residents were being abused by staff, assaulted by other residents, chemically restrained with drugs and not getting adequate pain control. A viral outbreak severely sickened 58 residents in November and December, and several were injured after falling in their own vomit and diarrhea, according to state and federal reports.
One state report said the care created a potential for 'unnecessary physical declines' in the last months of residents' lives.
But on March 11, Pinon met a critical deadline. The home passed inspection and was deemed in compliance with state regulations. Had Pinon not brought the home up to snuff, the state would have lost $475,000 a month in federal Medicare funds and faced closure of the facility.
Achieving that benchmark also meant a reprieve from the feds, who had been threatening to make the state pay back the $16.9 million the U.S. government had kicked in to build the facility.
The home was deficient in more than 70 of 150 federal standards, and while corrections are still being made, Pinon is hopeful the home will win approval in April from the Department of Veterans Affairs.
Veterans groups and lawmakers are happy with Pinon's work and glad the home appears to be back on track. But they also have questions about the agency they say created the mess: the Colorado Department of Human Services.
'Veterans are very angry about what when on. They think they deserve more. To end up with 400 pages of deficiencies is absolutely disgraceful,' said Marvin Meyers of the United Veterans Committee of Colorado.
'Something went drastically wrong.'
'A glorious day'
When the State Veterans Nursing Home at Fitzsimons opened its doors in October 2002, veterans' groups were overjoyed. They had lobbied for years for a Denver-area home so families wouldn't have to drive as far to visit their relatives. The state's other vets homes are in Rifle, Monte Vista, Florence and Walsenburg.
Vets groups had toured several premier facilities around the country, met for nearly two years designing Fitzsimons and even raised money to buy bushes for the landscaping.
Meyers remembers July 3, 2002, as 'a glorious day.'
'Everybody was shaking hands and congratulating everyone, and there were no thoughts of anything but a progressive movement toward filling the facility and operating it at the highest quality,' he said.
But things already were going wrong.
'There are lots of things that I believe were probably things that should have been reconsidered, even before opening the facility,' said Marva Hammons, executive director of the Colorado Department of Human Services.
First, Hammons said, her agency erred by overestimating demand. To break even financially, the 180-bed home needed to operate at 85 percent of capacity. Looking back, Hammons said she could have promised 75 percent or 77 percent. That was one of the reasons the facility lost $5.4 million in its first year.
Even more critical was staffing, she said.
State nursing home jobs in Rifle, Monte Vista, Florence and Walsenburg are considered plums. But in metro Denver, Fitzsimons competed with hospitals, nursing homes and other care facilities for good nurses during a time of nursing shortages.
Hammons, who has been on the job since 1999, argues that competition is still stiff with facilities that offer better pay and signing bonuses.
'In this environment, when nursing staff and other direct care staff are in such demand, it really makes it very difficult to hire the best of the best, even for a brand new facility that you might think would attract the best of the best,' she said.
Hammons also admits that the staff didn't get the proper training. State reports show nurses didn't know proper sanitary procedures, how to fill out reports or even prevent residents from falling.
But it wasn't just the nursing staff. Hammons singled out three key Fitzsimons officials for the problems. The top administrator, Mark Fuller, was fired in December. Fuller could not be reached for comment.
Two others, whom Hammons wouldn't name, citing personnel rules, were put on paid leave. One has since resigned.
'So you get those three people who are direct state employees who clearly have issues, and that compounds all the other issues,' she said.
Cleaning up the facility
Hammons, however, is quick to defend action her agency took in October, when some of the first state reports were published. They brought in managers from the state's other nursing homes and aggressively sought changes, she said, but there were too many layers of problems.
'It just was not enough to turn it around, despite their best efforts. And these are people who are managing well in other nursing homes.'
Enter Pinon Management, a Denver company in the nursing home business for more than 25 years. The staff's first order was to clear up the Norwalk virus outbreak among residents. It's the kind of intestinal illness that sometimes strikes cruise ships.Then Pinon hired new medical staff, increased training and assigned four teams to monitor state and federal standards that had to be met. The company also met with families and created a team to manage skin wounds, a chronic problem among nursing home patients that hadn't been addressed by the previous administration.
Pinon officials are diplomatic but say there were massive problems.
'When we see that level of problems in a facility, the leadership was the problem,' said C.J. Rocke, Pinon's chief operating officer.
New administrative and financial processes also are in place, but all involved said it will take time for the facility's culture to change.
An advisory committee organized by the governor has recommended that Pinon stay on the job for at least a year and maybe two. Colorado will pay Pinon $60,000 a month for its first six-month contract and $45,000 a month for the second six-month contract. The state also will pay for malpractice insurance, which could cost $750,000 over the next three years.
Meyers, whose group represents 460,000 veterans in Colorado, said he believes the home is being fixed, but he still worries about the future.
'(Vets) find it very difficult to think that this would go back to the same management in that department (of human services),' Meyers said.
Rep. Cheri Jahn, D-Wheat Ridge, is on the Fitzsimons advisory committee. She's uncertain who will run the home after Pinon but is certain watchdogs will be in place.
'I'm adamant about that,' she said.
INFOBOX
Problems reported by the state
* Medical staff ignored concern by the family of an 81-year-old man who had blood in his urine. He was admitted to a hospital, but the family wasn't notified.
* Fitzsimons failed to address three patients' 'bowel elimination needs.'
* Staff failed to protect an 84-year-old patient with Alzheimer's disease who was assaulted by other residents six times.
* A woman who entered the facility with one sore on her leg had three 'weeping lesions' within a month.
* An 81-year-old male patient fell 36 times in three months.
CAPTION(S):
Photo
Residents at the Colorado State Veterans Nursing Home at Fitzsimons gather for an entertainment program in January. The facility has been under state scrutiny for providing substandard care and was turned over to a private operator in December. On March 11, the home was deemed in compliance with state regulations. LINDA MCCONNELL / ROCKY MOUNTAIN NEWS
