Sudders acknowledges staffing problems at Holyoke Soldiers’ Home
Says more employees would not have prevented COVID outbreak
HEALTH AND HUMAN Services Secretary Marylou Sudders on Thursday acknowledged that staffing problems plagued the Holyoke Soldiers’ Home before the deadly COVID-19 outbreak, but said simply more employees or a different superintendent would not have made a difference.
“More fundamental is that there was not the internal processes, clinical management, and operations to withstand a pandemic,” Sudders said. “We left staff on the front lines without the clinical management, oversight, and support to manage through a pandemic.” Sudders said there was a “fundamental collapse of structure” that should have been in place.
Sudders testified for more than an hour before a legislative committee that is investigating the COVID-19 outbreak at the Holyoke Soldiers’ Home last spring. Since March 1, 77 veterans at the home have died after testing positive for COVID-19.
As far back as June 2019, the Moakley Center for Public Management at Suffolk University identified problems with staffing at the home. The home was employing the equivalent of 171 full-time nursing staff, when it needed 184.2 staff, according to its study. The home was using overtime, including mandatory overtime and per diem staff to cover hours, and there was a lot of staff turnover.
Sudders said the biggest staffing problem at the home, which led to the high turnover, was the lack of a permanent staffing schedule. Workers did not know their schedules in advance, which contributed to staff unhappiness and people more frequently not showing up for work. It also obscured staffing gaps.
Sudders said when she saw the Moakley report, “I was frankly stunned there had never been a permanent staffing schedule at the Soldiers’ Home.…That’s basic.”
Sudders did not say why a permanent staffing schedule was not put in place between June 2019 and when the pandemic broke out in March 2020. But she said a permanent staffing schedule has now been implemented.
Sudders also acknowledged problems with a lack of development opportunities for nurses to improve their skills, which led to turnover. She said a development program is being implemented.
But neither Sudders nor Secretary of Veterans’ Services Cheryl Poppe blamed the outbreak on staffing deficiencies. Sudders said the lack of internal management and processes were more significant. Poppe said it “may have been the way the virus actually hit the soldiers’ home,” and also the structural problems Sudders highlighted, with the lack of an immediate incident command structure in place.
However, Joan Miller, a nurse speaking for the Massachusetts Nurses Association at the hearing, disagreed with Sudders’ and Poppe’s assessments. “Staffing is a direct reason the crisis was what it was,” Miller said. Miller said with better staffing, COVID-19 could have been better contained. Pearlstein’s report noted that two units were combined into one because of staffing issues. Miller said she had to find her own personal protective equipment for herself and her staff.
While Sudders said staffing levels are adequate today, Miller said staff at the home believe there is a continuing need for more nurses and certified nursing assistants.
One recommendation made by the Pearlstein report is that the next superintendent should be a licensed nursing home administrator, which the superintendent during the outbreak, Bennett Walsh, was not. Baker has recommended, in legislation he filed, that preference for the superintendent’s role be given to someone with a nursing home administrator’s license, but he would not require that they have the credential.
Sudders said she is “conflicted” about requiring the superintendent to be a health care administrator, noting that Poppe, who previously led the Chelsea home, interim Holyoke superintendent Val Liptak, and Assistant Secretary of Veterans’ Homes Eric Sheehan, who was acting superintendent in Chelsea, all do not have a health care administrator’s license. Poppe said in the history of both soldiers’ homes, newly appointed Chelsea Superintendent Eric Johnson is the first to be a licensed nursing home administrator.
Sudders said she does not believe the pandemic’s impact would have been different had a licensed nursing home administrator been running the home as long as adequate “internal clinical and operating protocols” were not in place.
Miller said she believes that if a licensed nursing home administrator had been in charge, protocols for dealing with a crisis would have been put into place before the pandemic.Because the superintendent has not generally been a health care administrator, the Legislature in 2016 created a position of executive director of veterans’ homes and housing who would oversee the Holyoke and Chelsea soldiers’ homes. The position was to be held by someone with at least five years of health care management experience, but for four years the job went unfilled. It was recently filled by Sheehan, a former health care administrator at private nursing homes.
Asked what took so long to fill the position, Sudders said the language of the law led to “unclarity for us how to operationalize that position.” She said the idea of having an executive director within the Department of Veterans’ Services focused on housing did not fit into the departmental structure. “Individuals couldn’t figure out what it meant,” she said. She said the state restructured the job to be an assistant secretary role, focused on overseeing the home’s operations, particularly related to infection control.