A haven for vets: Director optimistic about July opening

Friday, April 13, 2001 | 3:32 a.m.

Inside the front door of the yet-to-open Veterans Home in Boulder City a haze of construction dust hangs as workers hustle to complete a job that's a year behind schedule.

Amid the exposed wires, unfinished floors, nonworking toilets and rooms with no beds, Jon Sias, director of the $21 million skilled-nursing facility, greets visitors with boundless enthusiasm and proudly shows off his diamond in the rough.

Unfazed by the fast-approaching July 1 opening date -- the sixth one -- Sias talks with great optimism about the home's future.

"Our goal is to make this facility a benchmark by which all other skilled-nursing homes -- private or veterans -- are measured," Sias says of the 180-bed facility at 100 Veterans Memorial Drive.

Sias keeps his sunny disposition despite construction woes that have delayed completion, cost overruns in the millions of dollars, a nursing shortage that threatens proper staffing and financial questions stemming from an inability to determine funding sources.

On top of that Sias has critics calling for his job, complaining about project shortfalls and demanding that state lawmakers consider turning over the facility, which has cost $2 million more to build than originally budgeted, to a private, for-profit firm.

And although the facility has overcome numerous hurdles, including two sites being rejected, it still has more obstacles -- some that could prevent it from opening -- to negotiate.

"We are pointing out serious problems that need to be addressed," Ed Gobel, Council of Veterans Organizations president, said. "We are not being negative. We are trying to do something positive because I believe we can still change things."

The council recommends that Nevada Office of Veterans Services officials who support Sias be held accountable for the facility's operation and that the state contact organizations with experience in starting veterans nursing homes.

Gobel wants the home to be privatized -- placed in the hands of a for-profit company that knows the ins and outs of making a nursing home successful -- and wants that operator monitored by the state.

That apparently is not going to happen, lawmakers say.

"We have already spent a lot of money to build the home, so now we have got to find a way to fund it," said Sen. Bill O'Donnell, R-Las Vegas, a Vietnam veteran who once supported privatization. "I'm not willing to jump ship now and privatize it.

"We have to step up to the plate or it is destined to fail. As it now stands, I don't think it is going to open July 1."

Divided groups

The issue of privatizing the facility is dividing veterans. Supporters of a state-run facility can point to homes in Boise, Idaho, and Yountville, Calif., as major successes, while privatization supporters say homes such as the one in Atlanta are the way to go.

Gobel has called for Sias to be replaced, saying he lacks experience in running nursing homes.

Sias, on the local job since late May 1999, served a nine-month residency in 1998 at the Bangor, Maine, Veterans Home, where he was taught everything from laundry and housekeeping to nursing and keeping medical records. He spent 10 weeks in administration at that facility.

Sias, a disabled veteran with a master's degree in public administration, said he met the criteria for the job: He is a veteran and he can be certified by the state to run the home.

Gobel adds the local veterans home was not built as promised, including scaling back from the original 115,000 square feet to 82,000 square feet and the elimination of aesthetic features such as aviaries, a reptile habitat, an aquarium and landscaping.

Gobel is especially critical of changing one bathroom for every two veterans to one bathroom for every four patients in most rooms.

Sias says those criticisms stem from what was seen in early artist's renderings and planning-stage suggestions that weren't in the final plans.

Still, Sias has found funds to build the animal habitats, which will have to be approved by the Legislature, he says.

As for bathrooms, Sias said a survey of various veterans homes found that 14 have the same configuration as Nevada's, five have three patients per bathroom and four have one bathroom per two patients.

Also, in the 24-bed Alzheimer's ward, two veterans will share one bathroom, and in nine isolation rooms, residents will have individual bathrooms.

The bathroom issue was addressed in staffing plans that call for the eventual hiring of 203 people when all beds are filled, Sias said.

"The industry standard is 10 to 12 residents to one CN (certified nurse) assistant, but we will have seven or eight residents to one CN assistant to help veterans get to places like the bathrooms," Sias said.

Sias, who served in the Navy during the Vietnam War, says there are a number of innovative things at the local facility. For instance, corridors are named as if they were streets, each of the three wards is called a neighborhood and patients' rooms will be referred to as residences.

"We want to eliminate that institutional feel that so many places have," he said.

The facility is not a home for old soldiers to go and wither away, but rather a place of hope where everyone who enters will be issued a discharge plan on admission day, he says.

"We plan to open with five residents." Sias said. "We hope to add two or three a day for four weeks, bringing the total ... to 45 by the end of the first month."

The facility has a waiting list of about 150 veterans of both sexes. To be admitted, an applicant must be a Nevada resident for 12 months, have served 90 days in the armed forces and have a physician's note stating that 24-hour skilled-nursing care is required.

Applicants need not be homeless or destitute, as had been discussed in the early stages. Also, they need not be combat veterans. In short, Sias says, veterans are veterans regardless of where they served.

Chuck Fulkerson, Nevada Office of Veterans Services executive director, says that the new local home "is just a start. By the time we build the second state home in Northern Nevada, we will have a better idea of what additional services are needed by what we learn here."

State veterans officials looked at other nursing facilities before building the Southern Nevada home.

"We went to places like Barstow (Calif.), and we liked the setup of its kitchen and its open, airy places, and modeled our home after that," Chuck Abbott, veteran's services management analyst, said. "We visited homes in seven other states and took the best features from each to use in our nursing home."

Shortages

But no amount of preparation could help officials in one area: becoming fully staffed in the face of a nationwide nurse shortage.

Lynn Stange, a registered nurse who serves as the home's director of clinical services, needs 10 registered nurses, 19 licensed practical nurses and 90 certified nurse assistants.

As of Wednesday she had hired four nurses -- two from out of state. "We are really hurting for LPNs," she said.

Christy Sawyer, a registered nurse and Nevada Service Employees Union's nurse alliance chairwoman, said every local facility is facing that crunch.

"There are 20,000 nurses in the state and only 3,000 are LPNs," Sawyer said. "Also, Nevada ranks 50th in the nation with 510 registered nurses per 100,000 population. California ranks 49th with 544 per 100,000."

Although salaries vary, Sawyer said the hospital where she works pays $37,880 a year for recent graduates of nursing schools to more than $60,000 for seasoned RNs. The state home will pay $35,000-$47,000 for an RN.

Stange, however, believes she can meet the staffing challenge and provided top services. She has set up interviews between now and late May, she says.

"We will focus on a high quality of care and quality of life with a higher-than-average staff ratio to residents," Stange said.

"We will not just be passing out pills and feeding and bathing the residents. We will have full-service speech, occupational and physical therapy in a community that will have a dining room and kitchen, a barbershop, a library with Internet capability, crafts and multiple outings."

It will cost $10.4 million a year to run the local veterans home, including $5 million for salaries.

But Sias and others haven't been able to answer a number of financing questions because it's still unclear how much insurance sources and other entities will pay and how much veterans will have to shell out. About $3.8 million a year will come from the government.

As many as 50 percent of the residents will be on Medicaid, Sias estimates.

"This is a very frustrating issue -- here we have a nursing home and the director cannot give answers," said Assemblywoman Vonne Chowning, D-North Las Vegas, the Senate-Assembly budget subcommittee chairwoman.

"They have to land on a final number, and it has to be approved before the close of the (legislative) session on June 4 or they will not open."

Chowning said, however, she is a lot more confident now about the home's future than she was before an April 5 hearing.

For instance, she said, one concern was that the home might not receive $54 per patient per day from the Veterans Affairs Department unless the resident served during war time. At the recent meeting, Chowning said she was told the VA would provide funding for all veterans.

Chowning also said that concerns that veterans would have to deplete their savings and perhaps lose their homes to get on Medicaid before they could be admitted -- as some critics claimed -- also are not true.

Still, she said, other specifics of financing, including what veterans will pay out of pocket, need to be resolved, and soon.

"How much it will cost out of my pocket is a very important issue," said Lee Keyser, who retired from the Army. "It has to be affordable, or veterans will go to other nursing homes that are less costly and offer better care."

Chowning said the local facility will be under scrutiny for two years.

"(It) will be required to make quarterly in-depth financial reports to the Interim Finance Committee, which I feel conveys to our constituents that we are monitoring this as much as possible," Chowning said. "It is a big piece of assurance."

Veterans' outlook

Virgie Hibbler Jr., Vietnam Veterans of America state council president, said he sure could have used the Boulder City facility last year.

"After my surgery I spent 54 days at home on my back -- time I could have spent in a place like this getting good treatment," he said. "This home will give veterans freedom -- another option for our health care."

Other veterans such as Chad Avery, a Disabled Veterans of America member, echo that sentiment. "I like the layout of the facility. I could be comfortable here because I would get to be with other veterans, and that's important."

Lou Rothenstein, an Army veteran and critic of the local facility, says officials are overestimating the importance veterans place on being with other veterans in a medical setting.

"I enjoyed the camaraderie of being in the service, but this is not like going to the VFW to have a drink at the bar and share war stories," Rothenstein said. "If I have to go to a skilled-nursing home, my No. 1 concern is good health care. If I have cancer, I want to go out fairly comfortable."

Bill Brzezinski, Disabled American Veterans adjutant in Nevada, says people need to be more patient. "We know now that the home is going to open someday. The real struggle was years ago, when we yelled and screamed to get someone to listen to us and stick a shovel in the ground."

Brzezinski and other veterans proved that a skilled-nursing facility is vital because of Southern Nevada's tremendous growth and ever-increasing and aging veteran population.

Short history

Nevada is one of three states that doesn't have a home for aging veterans. And the road to getting one has been rough.

The project lingered two years on the drawing board before federal money was approved for construction in 1996. But the project remained in limbo until January 1997, when then-Gov. Bob Miller committed the state's required 35 percent -- $6 million to $7 million -- to build it.

Because it lacked water pressure, the first location was switched in 1997 from a site near Nellis Air Force Base to Lamb Boulevard and Interstate 15.

That second site was rejected in May 1998 by the Interim Finance Committee after estimates said it would cost about $2 million to clean up contaminated soil.

Boulder City was selected in late 1998 after it acquired the property in a land swap with the state. Ground-breaking ceremonies were in July 1999, when Sias predicted the first residents would moved in the next July 1.

Construction began in October 1999, but fell behind five months later, causing officials to reschedule the opening for August and then for early fall.

Conflicts between the general contractor and subcontractors, architectural changes and wet weather pushed the opening to November and then to Jan. 1.

The cost overruns climbed to $900,000 by September, causing amenities such as $1 million worth of landscaping and the animal habitats to be put on hold.

The discovery of long cracks in the drywall in January -- a condition blamed on the building not being properly climatized -- again changed the completion date to March 1 and the opening to May 1.

Recently Sias said he is "85 percent confident" that the July 1 opening date would hold this time.

Then again, Sias does have the knack of finding a silver lining behind all of his dark clouds. For example, while the fish, reptile and bird habitats will not be present on opening day, the facility won't be without their calming influence.

Sias boasts that one of his first "hirees" was a pet-therapy director: Chester, a cat that will wander the place and provide company for the residents.

Now all Sias needs is financing, furnishings, a staff and patients.

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