State-owned nursing homes for SC veterans to open soon in Pee Dee, Upstate. What to know
Two veterans nursing homes in the works since 2015 are on the verge of opening their doors.
Veteran Village in Florence is set to open in late October and Palmetto Patriots Home in Gaffney is expected to follow in mid-November, state mental health officials said.
The state-of-the-art facilities, along with two others in the construction pipeline, should help alleviate a housing backlog for aging and disabled veterans that existed prior to the pandemic and have a significant economic impact on the surrounding communities.
A private nursing home operator with a mixed track record in South Carolina is being paid an estimated $30 million a year to run the homes, though two top state lawmakers told The State they have confidence in the company. Should Anderson-based HMR Veteran Services fail to deliver the quality of care South Carolina’s veterans deserve, however, the lawmakers said they’d take action.
Nearly 400,000 veterans live in South Carolina, roughly half of whom are 65 and older, but nursing home beds for veterans are few and far between.
The state’s health plan formula projects a minimum long-term care bed need for veterans in excess of 18,000, but existing state-owned veterans homes in Anderson, Columbia and Walterboro have a combined capacity of just 530 beds and were at full capacity with long waiting lists prior to the pandemic.
About 100 fewer total residents are living at the three homes today than were in March 2020, but all still have waiting lists, mental health officials said.
The new 104-bed homes in Florence and Gaffney will fill geographic gaps in the Pee Dee and Upstate regions, allowing veterans in those areas to remain closer to family while increasing the state’s bed capacity by nearly 40%.
The Department of Mental Health, which oversees state veterans nursing homes, hopes to break ground on additional facilities in Sumter and Horry counties later this decade, and has discussed building in Aiken County after that.
“We owe our veterans nothing less than the best care they can receive, especially when they need full-time nursing care,” said Senate Finance Chairman Hugh Leatherman, R-Florence, who chairs the Joint Bond Review Committee that approved the homes. “The regional facilities are vital to ensure their family and loved ones will be able to visit them regularly, which will provide a better quality of life for all involved.”
Senate President Harvey Peeler, R-Cherokee, who also sits on the committee, said opting to build the nursing homes “out in the communities” rather than in Columbia, where one initially was proposed, had been one of the best decisions the committee has made.
Peeler said the construction of Palmetto Patriots Home created jobs in his community and that he expects the Gaffney area to reap additional benefits once the facility hires staff and begins admitting residents.
The two new homes each cost approximately $60 million to design and build, split evenly between the state and federal government, and will cost significantly more per resident to operate than the state’s existing homes.
They have fewer than half as many beds as the Richard M. Campbell Veterans Nursing Home in Anderson and Veterans Victory House in Walterboro, but offer superior amenities and significantly more space per resident, said Mark Binkley, mental health’s director of governmental and legislative affairs.
“Anybody who visits them and sees the layout and the interior will be very impressed,” Binkley said. “These are going to be very, very nice homes.”
All residents will have private rooms with private bathrooms — a rarity at existing state-owned homes — laid out in 13-unit “neighborhoods.” In addition to a central dining facility, each neighborhood has its own bistro area with a small kitchen and dining room table, a gathering space and laundry facilities.
Peeler, who toured the Gaffney facility a couple weeks ago, called it “impressive, inside and out.”
“It doesn’t have the look or the feel of a quote-unquote nursing home,” Peeler said. “It’s more like a retirement or vacation facility. It’s somewhere you would be proud for your parent or grandparent or brother or sister to live.”
Private operator to run veterans nursing homes
In April, the state’s mental health department awarded VSI of South Carolina contracts worth up to $136 million over five years to manage both facilities.
VSI is controlled by HMR Veterans Services, an Anderson-based nursing home contractor that operates two of the state’s three existing veterans nursing facilities and eight other veterans nursing homes in Alabama, Maryland and Texas.
Anderson’s HMR, which bills itself as the “gold standard” in management services for state-owned veterans homes, has managed Richard M. Campbell Veterans Nursing Home in Anderson since 1998 and Veterans Victory House in Walterboro since 2006.
The company won the contract to operate Veteran Village and Palmetto Patriots Home following a competitive bidding process, albeit one without any actual competition.
As has often been the case over the years, HMR was the only operator to bid on the nursing home contracts, Binkley said.
Heyward Hilliard, HMR’s executive vice president of operations, said the dearth of bidders likely speaks to the fact that operating state-owned veterans nursing homes is a niche business, and a challenging one at that.
Only about 14 states, including South Carolina, outsource veterans home operations to private contactors, he said. And while other large nursing home providers operate veterans homes in addition to other nursing care facilities, HMR is unique in that it manages only state-owned veterans homes.
“Our approaches are designed around that,” Hilliard said. “It creates a specialized approach to what we do and the Department of Mental Health is a good partner in that.”
Peeler said he would have liked to see more operators bid on the contracts, because competition drives quality up and costs down, but that HMR enjoys a good reputation in the area and he was confident in their management of the Florence and Gaffney facilities.
While HMR has plenty of experience operating veterans nursing homes in South Carolina, the company also has faced its share of resident complaints and lawsuits over the years.
State regulators cited the company in 2018 for failing to thoroughly investigate or document allegations of abuse at Veterans Victory House. The U.S. Centers for Medicare and Medicaid Services issued the Walterboro facility more than $260,000 in fines after determining residents there were in “immediate jeopardy,” a designation the federal agency applies in crisis situations when the health and safety of individuals are considered to be at risk.
The company also has paid out more than $2.5 million since 2013 to settle at least 15 lawsuits brought by residents or their family members alleging negligence at Richard M. Campbell or Veterans Victory House, according to an analysis of South Carolina state court records.
Most of the cases settled for between $100,000 and $200,000, including one resolved last month that involved a former Veterans Victory House resident who claimed he suffered “significant personal injuries” after a fall at the facility last year.
HMR’s largest recorded payout was a $425,000 settlement reached on behalf of a Richard M. Campbell resident who was found in his bed on Christmas Eve 2015 with a latex glove stuck in his airway. The man, who was diagnosed with a urinary tract infection and hypoxic respiratory failure, died five days later, according to a lawsuit filed by his estate.
Binkley said he was confident HMR had resolved the deficiencies surveyors cited in 2018, and had no concerns about the contractor’s ability to adequately run South Carolina’s two newest veterans nursing homes.
“They have a long track record,” he said. “It isn’t unblemished, but they have overall a very good track record.”
Hilliard said he was gratified mental health officials had entrusted the company to run both new state-owned veterans homes.
To this day he said he disputes inspectors’ 2018 conclusion that Veterans Victory House officials failed to properly investigate abuse claims and crafted reports that inaccurately depicted residents’ experiences and outcomes.
“We kind of agree to disagree with that,” he said, adding that the facility has moved on and is currently in full compliance with federal guidelines.
Hilliard declined comment on lawsuits filed against HMR, citing company policy.
Past reporting problems at Veterans Victory House
Before its incident reporting issues surfaced in 2018, Veterans Victory House boasted a five-star, or “much above average,” rating, according to Medicare’s Nursing Home Compare website.
The home now has only two stars, or “below average,” and a one-star rating, or “much below average,” for its recent health and safety inspections, according to the federal nursing home guide.
The downgrade occurred after surveyors issued a searing report in December 2018 that found nursing home officials failed to follow their own incident reporting policy in all 16 cases they reviewed.
The inspectors found numerous instances where nursing home staff witnessed residents hit and injure each other or discovered residents with serious injuries, but allegedly failed to properly investigate or document how those injuries occurred. It also revealed that nursing home administrators had allegedly instructed staff members to obscure the incidents they witnessed in a way that made it difficult, if not impossible, to determine what actually happened.
Nurses were told to avoid using “hard words” in their reports, such as hit, punched, slapped or shoved, and instead opt for “soft words” like touched or made contact with. As a result, an incident where a resident repeatedly punched another resident in the chest was recorded as a resident being “touched with closed hand to chest,” inspectors found.
When surveyors asked the home’s administrator how one could distinguish between a friendly touch and a slap, which is considered abuse, the administrator said staff were told not to try and gauge the velocity with which a “touch” is made.
“The words punch and slap are opinions,” the director of nursing told inspectors, according to their report. “Opinions should not be documented.”
Hilliard contends that Veterans Victory House officials reported the incidents appropriately and chalked up the situation to a difference of interpretation.
“We felt strongly that our investigations were not just well-conducted, but they exceeded the requirements,” he said
Hilliard claimed the “soft” language HMR instructed nursing home staff to use in their reports had been taken directly from a training session South Carolina officials offered years earlier where another state’s investigative practices were held up as an example of proper incident reporting.
Binkley agreed with Hilliard that the issues at Veterans Victory House stemmed from a misinterpretation of reporting requirements and were not indicative of substandard care, but said still that the facility’s reports were clearly deficient.
“When we looked at them with DHEC (the Department of Health and Environmental Control), we agreed the reports were inadequate,” Binkley said. “It amounted to no report at all when reading the report was insufficient to determine what happened and what corrective action was taken.”
He said HMR had since straightened out its reporting issues and characterized the contractor as a responsive and reliable partner. All state-owned veterans nursing facilities, such as those operated by HMR, are subject to onsite contract monitoring, as required by the U.S. Department of Veterans Affairs, Binkley said.
Peeler and Leatherman said they would keep a close eye on the quality of care provided to veterans at the facilities opening in their districts and would alert the Department of Mental Health promptly if they have any concerns.
“My constituents are not bashful about reporting to me things that they think need to be addressed,” Peeler said. “So if (HMR) messes up, I’ll know about it.”
This story was originally published October 4, 2021 at 10:30 AM.