When Paul Barabani, a retired colonel from the Massachusetts Army National Guard, became superintendent of the Soldiers’ Home in Holyoke in 2011, he had a vision:
Transform the Soldiers’ Home from the “old” Soldiers’ Home, an aged facility where it was said veterans “went to die,” to a vibrant center of clinical excellence where veterans lived out the best possible years of their senior lives.
It might take years in the making, he said, but the first path to any goal would be charting a course. And that he did.
Then, I came over in 2013, inspired to follow such a leader.
First, Paul said, we would need to hire more staff and increase the numbers of hours per veteran care, which, he learned was much lower than state and national averages. Then, we would need to build more capacity to accommodate the enormous demand in the community for long-term care for veterans.
At some 200 or more applicants on any given day, there clearly weren’t enough beds to satisfy the number of veterans needing care.
Third was room size. Paul hated seeing veterans “piled into rooms” sometimes three or four to a room not larger than the average living room in your house. “In several of our rooms, veterans can hold hands with one another they are so close,” he would often say to visitors. In fact, today, many veterans can’t even use a walker or certainly a wheelchair to get to an inside bed in many rooms at the Soldiers’ Home because of cramped space.
To conform to trends in the nursing home industry and following recommendations from national experts, the Soldiers’ Home, would, in fact, need to expand room sizes and should move toward single room occupancy. Veterans, like everyone, want privacy.
Eventually, the state should also look at investing in adult day health care, where there is a large need in the veteran community. The state could take advantage of generous federal construction grants to help with the financing of these projects, Paul said, and he even reached out to Washington to secure support.
But all of these ideas take money and significant commitment from those at the seat of state government. And they assume a level of autonomy for the Soldiers’ Home leadership to make decisions that staff believe should be made in the best interests of their veteran residents.
On money and commitment, the home always struggles with its budget. The Soldiers’ Home is typically either level-funded or receives nominal increases. Given the current state budget shortfall, it’s a long hill to climb to expect any great infusion of spending support. On autonomy, it’s clear that those who make the decisions in Boston don’t take the time to understand the complexity of challenges we face in western Mass.
And so if you don’t get the money, the commitment or the autonomy, then you don’t have the means to achieve your vision.
So Paul decided it would be best to just concentrate on Job 1 – maintaining and sustaining the current mission of the Soldiers’ Home by increasing staff levels to where they need to be in order for veterans under his care to live with the greatest honor and dignity – the mission, itself, of the Soldiers’ Home.
But even that became an enormous challenge.
Appeals for help were met with either apathy or flat-out derision. At a legislative breakfast in 2014, Paul had the audacity to note that staffing levels at the Soldiers’ Home were far below state and national averages. Afterward, he was reprimanded by those in Boston and told not to bring up our staffing again. Any information we provided to legislators or meetings from that point forward had to be approved in advance.
Then in February this past year, after an inspection that revealed shortfalls in the quality of care we could provide, he sent a note — the first of many — to the state saying we needed more staff. Paul still hasn’t received an official response. “Do a study,” was the usual reply.
Then in June, the state implemented an early retirement buyout for employees that resulted in nearly 50 employees leaving the Soldiers’ Home in one day and causing massive stress on our staff and ultimately our veterans.
And then, like all state agencies, the home is under the constant scrutiny of potential budget cuts where it has to justify and defend every penny. This year’s budget isn’t looking any better.
So on Dec. 16 before the Board of Trustees’ of the Soldiers’ Home, after this perfect storm of events, Paul Barabani, the Chicopee son of a World War II veteran who came to state government with one intent to improve the care for elder veterans, announced his intent to retire. He had had enough.
And if Paul was leaving, I was, too.
After all, if Paul, as outspoken as he was, wasn’t getting the support we needed, how was I going to achieve our shared vision? I immediately announced my resignation and my last day was New Year’s Day.
On my way out, I told our trustees that the need in western Massachusetts for the Soldiers’ Home in Holyoke has never been greater. On any given day, there are at least 40 veterans waiting placement in the home who are either home alone in the community or have an elder spouse as their primary care provider or have a home health aide visit them for their primary source of care.
The veterans admitted to the home have more multiple and complex conditions than ever before — conditions that require regular assessment and require appropriate levels of nurse staffing. These are people who need 24/7 help for what most of us take for granted and what, in the nursing home industry, is referred to as activities of daily living — getting out of bed and dressed, bathing, eating, and using the toilet.
We continue to see an intense layer of challenges that require individualized care and greater numbers of staff.
This is not just my belief but the belief of the experts, members of our staff, and certainly those who know best about patient safety.
At a hearing with state leaders, Lee Tonet, a retired nurse from Northampton, agreed that the Soldiers’ Home needs more nurses. Her husband, Earl, a former Williamsburg High School athletic coach, was a resident before he died at his own home in October. “There’s not enough of them and I am telling you, sir, that (the veterans) are not getting the care that they need,” Tonet told the state’s secretary of Veterans’ Services.
The predicament at the Soldiers’ Home is not unlike the struggle of many facilities across our state that provide care for senior citizens while dealing with decreased revenues and increasing staff shortages.
At the Soldiers’ Home, I would regularly hear from family members of residents whose care before coming to the home was affected by staff shortages in nursing homes. Staff shortages can and do result in malnutrition, dehydration and bed sores. The more frail or demented the patient, the more serious the impact.
In a national report I recently read, it was noted that many nurse leaders believe that decisions affecting staffing levels are made by people in corporate offices who are removed from bedside care and often without consideration to the hours of care actually required by the residents they serve.
In my view, in the case of the Soldiers’ Home, this is certainly true. If we continue to ignore the problem, our elder veterans won’t receive the care they have earned and deserve.
John Paradis, a retired U.S. Air Force lieutenant colonel, lives in Florence and writes a monthly column that appears on the second Friday in the Daily Hampshire Gazette.
