Dignity Alliance Massachusetts urges the Commonwealth to put aside the current proposal to construct a 235-bed, congregate care facility and, instead, follow the Veterans Administration’s Small House Model Design Guide to create resident-centered communities focused on the needs and preferences of veterans. The Small House Model provides exceptional rehabilitative and hospice care and chronic disease management, with sufficient staff and equipment to support all personal care and assistance needs, using intentional communities of approximately 10 residents living in homes with private bedrooms with full baths. The guiding principles are autonomy and dignity.
Instead of building a monument to our past failed efforts at institutionalization, the Commonwealth should consider developing a living memorial in the form of supportive living and services that reflect the Commonwealth citizenry’s concern and gratitude that we have for veterans. The Commonwealth should take this opportunity to accelerate the decarceration of veterans and reform the institutional system that cares for veterans in Massachusetts. This policy would address the causes of deaths in nursing homes. The first is the actual buildings themselves, of which the Holyoke Home is an example. We know that density contributed to the spread of the pandemic and many other infections and consequent deaths. We also know that 30 and 40-bed units with two and four people in a room are not conducive to infection control, let alone a quality residential setting. The fact is that they are designed primarily to be cost-effective. Any building constructed must be less dense – pod-like, small building-like systems, or a series of smaller homes linked together programmatically. Infections spread much less in this type of facility.
Further, efforts to provide more homelike settings are underway in the Veterans Administration itself, in its Small House Design and Heroes Ranches initiatives – options the architectural consultants here chose not to follow, instead relying on outdated licensing criteria. The Commonwealth itself recognizes that most older adults want to age in their communities – only 4% express an interest in nursing facilities. Given the Commonwealth’s work to rebalance its long-term services and supports away from nursing facilities and towards home and community-based programs and services, it makes little sense to abandon that blueprint when it comes to the care of the state’s veterans.
The COVID-19 pandemic laid bare the defects of large nursing facilities. Over 50% of the deaths in Massachusetts have been residents of congregate care facilities. According to a Veteran’s Administration’s spokesperson in May of last year, only one veteran from all 13 of the VA’s small-house model nursing facilities tested positive for COVID-19. In contrast, 25 veterans tested positive in a three-week period at the end of March, beginning of April in 2020, and all 25 died before the end of April.
Additionally, the precautions taken ostensibly to protect residents during the pandemic have left them alone and isolated from their friends and loved ones. Notably, many veterans already bear this burden in having to move far from their families and home communities to receive nursing facility level care at the Soldiers Home. Building one huge facility to serve the unique needs of a diverse population of veterans throughout Central and Western Massachusetts only further cements the unnecessary segregation and institutionalization of older and disabled veterans. Evidence does not support the creation of a “bigger” facility. The improvement of veterans’ outcomes and satisfaction depends on adopting the Small House Model of resident-centered care.
The pandemic allows the state the opportunity to reform the system. We can do better in Massachusetts, particularly for veterans. The state de-institutionalized state schools for those with developmental issues, moving them into smaller, less abusive settings and homelike settings. The price tag of $400 million allocated in smaller, local, cost-effective facilities would go a long way to meeting veterans’ needs across the Commonwealth and not just in two large institutions.
A crisis is too valuable to waste. The lives of these veterans and others who died during this pandemic are too valuable to have died in vain. Going back to the old way without reform dishonors those who have died. Are we not better- by creating living memorials in the form of small communities than in constructing large edifices that will serve as Petri dishes for the next way of viruses that infect us? We recommend that the Commonwealth use its resources to transform and modernize its system of care for veterans and create a more homelike system of smaller and safer environments that would protect veterans from future pandemics and provide a more homelike setting.
Download the statement, including Dignity Alliance Massachusetts member endorsements: Policy Statement Holyoke Soldiers Home.docx.