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'We can only do so much'

PERRY POINT — PERRY POINT -- The paint is peeling on the square columns outside the 80-bed nursing home at the Perry Point VA Medical Center. The building is in better shape inside, but while the peach and sea foam-green walls are cheerier, they hide flaws, too: uneven heating and cooling systems, poor floor designs and wires and pipes that keep maintenance engineers hopping.

The building's slow deterioration comes as no surprise: Built in 1924, the two-story nursing home is older than many of the patients it houses. At nearly 80, the building is nearing the limits of its usefulness, extended with patchwork fixes by a staff that hopes daily for a new facility in the next few years.

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The building's shortfalls have not compromised patient care, but in a few years it might be harder to make that reassurance, said Dennis H. Smith, director of the VA Maryland Health Care System.

"What's going to happen in five or 10 years?" Smith asked. "We're struggling now. We have a great staff, they do a great job, but it's a challenge."

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The nurses and other staff find their time stretched thin. The home's older, U-shaped floor plan means that there are rooms the nurses can't see, a potential danger for the patients.

The staff reserves the rooms nearest the nurses' station for the patients with the greatest need, said Iris Hernandez-Autry, a nurse manager, but that doesn't entirely solve the problem; it just means the staff tries to manage the amount of running they must do each day.

When they're not running, the staffers are often on the phone to maintenance, asking for help with the latest breakdowns -- like the uneven heating and cooling systems, which leave some patients too warm while others in a different section ask for blankets.

"When I call their [engineering] services, they say, 'All right, what do you want now?' " Hernandez-Autry said with a laugh. The staff, she adds, often improvises solutions while waiting for more permanent fixes.

Other features of the building not only slow down the staff, they also make life at the home less convenient for the patients, many of whom have mental health concerns like Alzheimer's or dementia.

Most rooms don't have the tubless bathroom that would allow nurses to wheel a patient into the shower. Instead, those patients use the community shower room, which is equipped with a special bathtub and facilities for patients on stretchers.

And the large beige bathtub in the community room should be updated, too, said Sherry Lyle, another nurse manager. "It's a safety issue," Lyle said, noting that newer tubs can better accommodate patients with amputations or mobility problems.

Although the aging building has been a concern for years, help could be on the way. The VA just released a draft plan of an ongoing infrastructure review, Capital Asset Realignment for Enhanced Services, or CARES. Part of that draft called for a new nursing home to be built at Perry Point.

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The new building would cost about $30 million, said Guy B. Richardson, the associate director for finance of the VA Maryland Health Care System. That amount would include design and planning for the new building as well as demolition of the old structure.

A new building could also consolidate the 80 beds in Building 9H with a second nursing home on campus, which holds another 50 beds, Richardson said. That facility is, at 70 years old, just slightly younger than 9H.

If the plan gets approved, a new nursing home could potentially open around 2008, Richardson said.

There's already a possible site for new construction, across the street from the current building. And the staff have their own wish list ready, too.

A floor plan like a wheel would be more modern, said Dr. Mark Heuser, the service manager for geriatrics and long-term care at the home. The nurses' station would be at the center, with patients' rooms radiating out like spokes. Each spoke could have a different decorative theme, like sports or animals, to help patients with cognitive impairments better orient themselves.

A modern building could also incorporate some of the technological advances that make nursing homes work better.

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For example, Perry Point's system to stop patients from wandering off is antiquated, Lyle said. Doors to many of the community rooms are locked, and only the staffers have keys. The Dutch doors, in which there are a top and bottom half that can be opened separately, are a "19th-century wander-guard system," Heuser said.

While this does prevent wandering, it also restricts patients able to get around on their own, Lyle said. And staffers have to let visitors in and out.

Modern systems feature bracelets that patients can wear, which electronically trigger door locks for patients who might wander.

Yet a new building is far from being a sure thing. Although it's the highest priority of the VA in Maryland, the CARES draft calls for 12 new nursing homes, spread across the country from Los Angeles to St. Albans, N.Y.

And with hundreds of buildings in the VA, Smith said, "there are probably things in the VA that are in worse shape." The nursing home may be on top of Maryland's list, but there are needs in every state. "How it will fall out nationwide is anybody's guess."

Still, Smith said he's cautiously optimistic, and some of the staff seem to share at least some of that feeling.

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"I think the need is recognized as legitimate," Heuser said.

For Hernandez-Autry, the debate has a personal dimension: she not only cares for the veterans, she is one herself. A major in the Reserve, she recently spent about seven months in Afghanistan. Hernandez-Autry returned to the nursing home early last month.

"We try hard. We work hard to keep it as uplifting as possible," Hernandez-Autry said.

But, she added, the staff is limited: "We can only do so much with it."


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