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Full Audit: Grand Rapids Home for Veterans didn’t check patients, study complaints

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GRAND RAPIDS, Mich. -- A state audit says workers at the Grand Rapids Home for Veterans falsely claimed they were checking on patients after being alerted of possible falls, failed to properly investigate allegations of abuse and neglect, and took too long to fill prescriptions.

The veterans home also continued with inadequate staffing levels even as the state filed four complaints against the contractor hired to supply nursing aides.

Auditors used surveillance video to show only 47 percent of bed checks and 33 percent of fall alarm checks were done, even though the home had produced documentation that the checks occurred.

CEO of Michigan Veterans Health Leslie Shanlion said that there have been decades worth of complaints with the Grand Rapids Home for Veterans. She was appointed to the position in October, just as the auditors were wrapping up their investigation, and says that going in she knew things weren't good.

"The audit reflects a lack of leadership, a lack of current policies, procedures, and training, and a lack of accountability," Shanlion said.

The audit was made public Thursday, a day early, after Rep. Holly Hughes, (R-Montague) called the findings "very disturbing."

She said in the statement that the "mistreatment of our nation's heroes is unacceptable and must be stopped."

The investigation by the Auditor General has been worked on for two years.  Hughes tells FOX 17 that she was made aware of the report Wednesday afternoon and has just seen a preliminary report.

Click here to download the full 44-page report (PDF)

Hughes calls the investigation very detailed and there will be reports of "abuse, neglect and mishandling of things, that it's just deplorable."

"We will get to the bottom of this and demand accountability from the people responsible, whether that be further inquiry, reprimands or job termination," Hughes said in the release. "Our veterans deserve the best possible care and we'll examine what needs to be done to keep that promise to them."

The Michigan Veterans Affairs Agency says it is making changes to comply with auditors' recommendations.

Democrats firing back

“Holly Hughes saying she’ll get to the bottom of the mistreatment of Michigan’s veterans is the height of hypocrisy,” said Brandon Dillon, Chair of the Michigan Democratic Party in a press statement.

“If she wants answers and accountability from the people responsible for the horrendous conditions at the Grand Rapids Home for Veterans, she needs to look in the mirror. Her vote, in 2011, for the budget that cut $4.2 million from the Grand Rapids Home for Veterans and privatized the care of our servicemen and servicewomen is what caused this crisis of neglect for Michigan veterans. If Hughes wants to contribute to the solution this time, instead of the problem, she should demand that this contract be canceled and the dedicated employees who served our veterans for so long be brought back. It’s time for this experiment on our veterans to end.”

The Associated Press contributed to this report.


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    Seems to me I recall the VA situation was a HUGE issue during the 07 presidential election.
    As I recall, it was “the republican’s fault” and promises where made to repair the VA situation.
    Then again “if you like you doctor, you can keep you doctor” was also promised.

    • Workedthereonce

      With a war within the veterans home between state staff and contracted staff a problem for years, and contracted staff being victims of abuse from state staff, its no wonder standards in care and staffing levels are a problem. It is time for change and for the staff to work as a team instead creating problems. I urge anyone who relates to this story to offer our veterans help in the best way they can Volunteer. We could all support our hero’s!

      • Jo Wobble

        Get serious. The contracted help is the problem. Their attitude is that they have carte blanche to act how they want. And hiring on ‘the cheap’ leaves the VA Home with non english speaking care givers. THIS IS UNACCEPTABLE. Privatizing to save money is what brought this problem to light. We also just gave a tax increase. WHAT THE HELL?
        When no one has to answer…..all we get are unanswered questions. ABUSE was not addressed.

        • Oliver

          I worked at the veteran’s home as a contracted worker and none of my co-workers were “non-english speaking.” You don’t have the inside scoop. You are both right and wrong about contracted workers having “carte blanche to act however they want.” There are rules, cameras, and witnesses, so there are some protections against abuse and neglect. However, I know a story of a lady who was fired for abuse and neglect and she was hired back later because the home is so desperate for employees. The real problem is that the State tried to “cut costs” by using the private contractor. This job offers low wages and nobody wants to do it. Working in a nursing home is already a stressful job, who wants to work for low wages on top of that? Thus, there is a staffing shortage almost every day on almost every shift. The veteran’s home could turn around tomorrow if they offered $15 or $16/hr. People would flock here for the job, eliminating the staffing shortage. There would actually be a surplus of applicants for the job, and the employers could choose the best of the applicants to provide the best care. Right now, the vet’s home hires anyone and everyone, and let me tell you that 80% of the people who worked there are human garbage, troglodyte-looking cretins with poor educational background, attitude, and poor outlook on life. They don’t treat anyone well: not me, not their co-workers, not the veterans. Another big problem is the fact that meds are given out by LPNs who wheel a med cart around on the floor. It’s not hard to become an LPN and they have a lot of responsibility, as each individual LPN is responsible for passing meds to an entire floor, which is sometimes 25 to 30 people. The med list for just 1 veteran can be upwards of 15 meds. I don’t think this is the type of job that a LPN should be doing. It should be a certified Registered Nurse passing meds, and it should probably be more than 1 person for each floor. I’m obviously correct, given the problems with medications the home is experiencing (as Fox17 is reporting in this story). There are also many other shady things going on in that place than what this news story covers, but I won’t talk about all of that. Just take it from an insider than this story is factually accurate.

          • LPN guy

            are yoIu a nurse oliver? I am a LPN and its not easy to become one. We get alot of training theres only a few things we cant do in michigan. but other states we are equal to RN. so if you are not a nurse. keep you mouth shut.

          • Catherine Andresiak

            I worked at this Establishment for over a year as a Nursing Supervisor. This problem does not fall on the backs of the CNA’s. Many of my CNA’s were very hard workers, conscientious and cared about these guys. This problem lyes within the structure of the Agency the state took on to hire CNA’s and Nursing Supervisors to Supervise these CNA’s. Nursing Supervisors were required to work as CNA’s 80% of the time, due to the shortage of CNA’s. CNA”S were paid a very low wage for a very difficult job……….9-10 dollars an hour, crap benefits. They were mandated almost every single day to work a double shift, with whom many had children they had to tend to after work, they were told to find a babysitter or be fired or written up, I watched many of them cry not knowing what to do with their kids….Unforgiving! If they would have started out paying a decent wage to these CNA’s, the turnover would not be so great and they could have built a solid staff, however, greed is a common factor in what this agency was willing to pay to have the Veterans taken care of properly! Everyone was only thinking of money..Agency low balled bid to get the contract, Veterans Facility took the low ball offer to save money, not thinking how much this operation would actually cost..poor management to say the least!
            Now our Veterans are paying the big price. How many patients can a CNA-LPN take care of on one given day, most of these guys are very ill and need way more help than what they are getting. I witnessed some hideous things working here for our Vets. A member had his legs bandaged due to leg ulcerations, when he finally was given a bath, bandages were taken off and hundreds of worms were crawling around in his sores, he was taken to the hospital and died shortly after due to sepsis! Now, was this the nurse’s fault, maybe, however, how many patients is she responsible for per day and is it even possible to care for 35-50 patients while also being responsible for a very heavy med pass. It is time to look at nurse/patient ratio and do what is right for a change!!!!!!

    • Andrew

      That is the key, right there.
      This place should be shut down or handed over to the feds to run like a REAL VA should be run. They can build all the lovely landscaping they want, but if the vets are being abused it has no place in this community and should not be receiving one penny of our tax dollars.

  • Common Cents

    Sure, I’m a callous piece of “work” but I don’t care if veterans die/get run over/whatever. They KNEW what they were signing up for. They were signing up to be paid murderers for a government that, if you believe everything you read, is subject to the whims of a nation that knows more about television game shows than international politics. Soldiers/veterans are the lowest scum on Earth to me.

    • cathy

      Everything is about a money! I worked there through an agency, they never, I mean never have enough help, mostly nursing assistants because they pay them 9-10 dollars an hour with crappy benefits! And each CNA has too many veterans to care for….I was a Nursing Supervisor at this facility and most of the blame is not to be toward the CNA, many of them were very dedicated and cared about those guys….The REAL PROBLEM is with the AGENCY they hired to contract CNA”S and Nursing Supervisors! They are so short with CNA’s All of the Nursing Superisors are expected to work as CNA’s… And there is NO LEVEL OF RESPECT FOR EMPLOYEES! Many CNA”S are required to work double shifts everyday, some of these CNA”s were completely exhausted, A few of them even had accidents on the way home falling asleep at the wheel! This problem does not fall on the backs of 95% of the CNA’s. The turnover rate at this facility is overwhelming due to low wages, too much work for one person to perform accurately within an 8 hour shift! Conclusion is GREED from Contracted agency not paying employees more than slave labor wages. State LPN’s have way way to much work to do! When I was there a veteran’s legs were bandaged from leg ulcers, when this gentleman was finally given a bath, in removing his bandages, his legs were full of worms crawling in his ulcerated sores, he was taken to the hospital and died there due to septic infection! Was it the nurse’s fault, maybe, however how much can one nurse do for 35-50 patients as so many of them need critical care! This is an outrage against our Veterans and this is just one incident I witnessed of many! This is an outrage to the Heroes of our Country!

    • Dennis

      Wow, you are an arrogant SOB that really needs to leave this country and never look back. You get to speak that way while riding on the coattails of those men and women who died for your freedoms. Maybe you need to look in the mirror when you speak of cum of the earth, and I guarantee you will find it. It is people like you who should have no voice and be mandated to be on the front line somewhere. Yes we know what we signed up for, and I would gladly do it again if it meant that my children and grand children remain free and not slaves to governments that don’t care about freedoms. Our problem is that we, as a Country have gotten too far removed from God and what we were founded on in the first place. Be part of the solution and not the problem and SHUT THE HELL UP!!!

  • Dhill

    The VA is dropping the ball all over the field. I went to the VA down to battle creek to get an X-ray on my elbow. Found out it was fractured. Called and left several messages to my primary doctor. That was done in November. Still nothing. Called to get an appointment for therapy for anger management. Can’t get in until April26th. This is Howe the VA works.

  • Renee

    This is what you get when you get rid of unions and privatize. !! Emergency managers, privatizing services like Dean transportation, etc. You get what you pay for. Right to work. Thanks Snyder. You are the Worst thing that has happened to michigan.

  • Kam

    My experience being proactive and vigilant for my mom who still lives at the Veterans Home has been an emotional journey for 6 years. I’ve been met with derision, eye rolling, disregard, blatant lies, fishy cover-ups, nonexistent records,and shoddy complacent daily care,at all levels of staff and by dour,distracted lazy employees .By the grace of God and family vigilance mom is still with us. As an especially vulnerable resident ,we let mom think she is in “a good place” yet almost daily it’s a battle to ensure she is afforded basic hygienic care and some semblance of dignity, exercise and engaged in some activities . The trust has been long gone and the bottom line is ,these are people caring for people, I would say trust no one and trust your instincts.Family members, Be present, proactive and involved. I’m hopeful that change will begin for all the residents. More heads should be rolling, but I don’t see that happening. As for the comment made re should the nurse with a large caseload be the blame for the unbathed veteran that had maggots in his skin ulcers, absolutely! and any one else that ever came in contact with him in the guise of a caregiver. One of the biggest hurdles is the pass the buck,deny any knowledge of , and support the lying coworker agenda that is prevalent. Hell hath no fury like a child turned parent…

    • Truth

      I worked in a nursing home, very depressing. We were always short staffed, working extra hard to pick up the slack of all the employees that called out… to have family waltz in and demand their family take priority over others… I have since quit and would never go back. My suggestion to the family of nursing home patients, take them home and care for them, put some gloves on and assist in their care. It’s easy to complain and point fingers. what’s wrong with our culture that’s it’s acceptable to write off the elderly? Families force them in nursing homes because their care is an inconvenience.

      • Kam

        Such a witless broad statement as to families being inconvenienced. My mom was put in the Veteran s home by her husband, a stepfather that because of his obsessive need for control without rational whether it was detrimental to our moms well being or not . Now that the comment is well over a year old, our worst nightmares came to an end when mom passed after repeated fall and injuries to the head and broken bones ,all of which transpired when myself or siblings were not present, and we were there alot,daily. If mom had lived in safe loving home with us , surely a preference to the constant fear and stress we experienced firsthand .

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