Critics say Holyoke Soldiers’ Home chronically underfunded
Differences in residents’ needs make comparisons to Chelsea difficult
THE OUTCOME OF COVID-19 at the state-run Holyoke and Chelsea soldiers’ homes could not have been more different. The Holyoke home was the site of a massive outbreak in which 76 veterans died, and it became a national example of how not to handle a pandemic. Attorney General Maura Healey announced criminal charges Friday against the former Holyoke Soldiers’ Home superintendent and medical director. In Chelsea, the virus was more contained, and veterans’ home superintendent Cheryl Poppe was elevated to acting state secretary of veterans’ services when Secretary Francisco Urena resigned over the Holyoke debacle.
For former Holyoke Soldiers’ Home superintendent Paul Barabani, who is helping lead the Holyoke Soldiers Home Coalition, a new group advocating for more funding for the Holyoke home, the latest chapter is a tragic outgrowth of long-running disparities that disadvantage the Holyoke Soldiers’ Home compared to the Chelsea home in funding and staffing.
Barabani, who resigned in 2016, raised the disparities in his recent testimony before a congressional subcommittee exploring issues related to oversight of soldiers’ homes during the pandemic. Barabani said in an interview that funding data show clearly that “something’s wrong here.” The disparity, he said, has “gone on year after year after year.”
While an independent investigation into the outbreak by attorney Mark Pearlstein is complete, a legislative oversight committee is examining the Holyoke Soldiers’ Home outbreak, as is US Attorney Andrew Lelling.
A look at the data finds no clear answer to the question of whether Holyoke is underfunded compared to Chelsea. While the funding levels between the two homes are different, so are the size and populations of each.
The budget provided by the state for the Chelsea Soldiers’ Home has always been larger than Holyoke’s. In fiscal 2020, the state budget allocated $29.2 million to the Chelsea Soldiers’ Home and $23.8 million to the Holyoke Soldiers’ Home. In the three prior fiscal years, the Holyoke Soldiers’ Home got around $22.5 million in the state budget, while the Chelsea Soldiers’ Home got around $27.2 million.
A separate pot of money from the purchase of veterans’ license plates has, since 1992, been split 60–40 between the two homes, with Chelsea getting $600,000 annually and Holyoke getting $400,000. Although this divide mirrors the breakdown of total beds at each facility, it has irked some supporters of the Holyoke Soldiers’ Home.
Much of the debate over funding equity centers on which one of two major data points is considered. Chelsea’s higher budget allocation can be seen as justified based on its higher total bed count, while arguments that Holyoke is underfunded rest largely on the fact that far more of its residents require expensive higher-level care.
The Holyoke Solders’ Home has just 278 beds compared to 444 beds in Chelsea. But the Holyoke home has more long-term care, or nursing home, beds –– 248 compared to 139. The rest of the residents are living in dorm-style apartments, so far less money is spent on their care.
The fiscal 2020 budget for the two homes, on a per-bed basis, translates to around $85,800 per bed in Holyoke and $65,900 per bed in Chelsea. (These figures, based on the state budget allocation, do not take into account some additional small sources of revenue.) The per capita allocations suggest that Holyoke’s higher-need population is being taken into consideration, but critics say an even larger budget adjustment is warranted based on the Holyoke home’s mix of residents.
Barabani says it would make more sense to look at how much money is spent on clinical staff for each long-term bed. He calculated, using 2019 figures, that medical and nursing staff were paid, on average, $53,700 per long-term bed in Holyoke, while medical and nursing staff at Chelsea were paid on average $86,900 per bed per year.
The Chelsea home also has 66 beds for which it can bill Medicare for skilled nursing services, while Holyoke has no Medicare contract.
The biggest expense in a facility is staffing, and whether staffing levels are adequate – and consistent between the homes –– has long been an issue.
According to the Office of Health and Human Services, Chelsea has 310 full-time equivalent staff: 162 are clinical staff, 30.9 are in administration, and 117.1 are in facilities/maintenance. Holyoke has 283.3 full-time equivalent staff: 187.1 clinical staff, 33.5 in administration, and 62.7 in facilities/maintenance.
The reason for the major disparity in facilities staffing is that the Chelsea campus is twice as large, with 11 buildings compared to Holyoke’s four buildings.
A June 2019 report by the Moakley Center for Public Management at Suffolk University found that to meet its nurse staffing needs, the Holyoke home should have been employing 184.2 full-time nursing staff, but it was only employing 171.
The report found that the Holyoke home was using overtime and per diem staff to cover a lot of hours, paying on average $44,000 a month on overtime. The report noted that nurses working extra shifts are more likely to be tired and make mistakes. While the home was trying to hire new staff, there was a huge amount of turnover, with half of new hires in 2018 no longer employed by the end of the year, many because they were fired.
The Moakley Center conducted a similar survey of Chelsea’s staffing in 2017. It recommended hiring 10 additional facilities and maintenance staff. Chelsea also had a huge overtime budget for nursing staff –– more than $400,000 over one six-month period – but its problems were more organizational. Chelsea’s number of nursing staff actually exceeded industry standards.
Barabani, in his congressional testimony, suggested that the heavy reliance on part-time staff at Holyoke could have contributed to the virus’s spread, since part-time workers often hold multiple jobs and could bring the virus in from another facility. A part-time worker with two jobs may also be more likely to call out sick if one facility becomes a virus hot-spot.
The Office of Health and Human Services acknowledges that Chelsea’s workforce has a longer tenure, which is why it has a higher rate of pay.
The quality of the building also plays a role in budgeting and safety. In addition to the Chelsea Soldiers’ Home being much larger than the Holyoke one, Chelsea’s facility is older. The Chelsea Soldiers’ Home opened in 1882, while the Holyoke home was built in 1952.
Because of its size and aging infrastructure, the Chelsea home spent $1.57 million on utilities in fiscal 2019, while Holyoke spent $550,000.
The state began designing a new home in Chelsea in mid-2017 and secured federal funding in 2018, with construction on the $199 million project expected be completed in 2022.
A plan to expand and renovate the Holyoke home was drafted in 2012 but never funded. State officials only took that plan off the shelf – with plans to review and revise it – last month in the wake of the COVID-19 outbreak.One state official said Chelsea’s renovations were likely prioritized because Chelsea was at risk of losing federal funding if the renovation did not proceed, since the home did not meet federal guidelines. Pearlstein’s report wrote that Holyoke’s facility is generally in better shape than Chelsea’s.