Deficiencies in the Assessment and Care of a Patient Seeking Geriatric Services at the Fayetteville VA Medical Center in North Carolina

The VA Office of Inspector General (OIG) conducted an inspection at the Fayetteville VA Medical Center in North Carolina to determine the validity of allegations that facility staff failed to coordinate appropriate care for a patient seeking community living center (CLC) placement and respite care, and did not provide medications for the patient while at a community assisted living center. The OIG did not substantiate that the facility failed to coordinate placement for a patient seeking CLC care. The facility evaluated the submitted consults in a manner consistent with policy, and disapproved CLC placement when the patient’s functional status did not warrant placement. In the fall of 2020, the patient was approved for community nursing home placement. However, the facility failed to coordinate respite services for the patient. Community health staff did not properly determine the patient’s eligibility, and an interdisciplinary assessment was not completed to determine the patient’s eligibility as required. The OIG did not substantiate that the facility failed to provide medications for the patient while at a community assisted living center; however, when the patient needed to be seen by a community optometrist to obtain glaucoma medications, a community care optometry consult was not initiated. The OIG also identified that the psychiatrist used the involuntary commitment process in a manner that was inconsistent with the state’s established parameters, and failed to adequately assess and document the patient’s capacity to make informed decisions and determine whether the patient had a healthcare agent. In addition, the patient’s primary care providers and psychiatrist missed an opportunity to coordinate specialty care needs for the patient. The OIG made seven recommendations related to the evaluation, assessment of, and staff training for respite services; the psychiatrist’s use of involuntary commitment; patient decision-making capacity; identification of healthcare agents; and initiation of specialty care consults.