Before he accepted the appointment from Governor Brown to head the California Department of Veterans Affairs (CalVet) in 2015, Vito Imbasciani MD made his rounds to some of the Veterans Homes of California.
“I wanted to see what I was getting myself into,” he quipped. With decades of experience as a physician, including 27 as a military surgeon, he wanted to elevate the quality and levels of care at the Homes, and particularly those with skilled nursing facilities (SNFs). By the time he completed his third month on the job, he’d seen them all. What did he find?
“Uniformly talented and dedicated staffs burdened by antiquated systems of support,” he said. “It is as much their mission as a job. But they were still working with paper charts, and an old system of delivering meds that was inefficient.” In fact, each facility had its own established practices that were not consistent across the network of Homes, Imbasciani said, which in part explains why the Homes had two-star ratings when the goal is five stars. To improve, they needed to operate as a system, not individually.
By the time U.S. News & World Report released its 2018-2019 rankings for nursing homes in October 2018, his vision had been realized. The Homes at Barstow, Chula Vista, Fresno, and Redding all received 5-star ratings. Yountville – one of the oldest veterans homes in the nation – received a four-star rating. And, in 2019, all eight of the Homes passed their annual federal and state inspections with flying colors.
The marked improvements reflect unification of the Homes’ practices. Imbasciani credits Coby Petersen, CalVet’s Deputy Secretary of the Homes Division, and Thomas Bucci, a former prosecutor who is now CalVet’s Director of Clinical Services and Long-Term Care. As former military officers, Petersen and Bucci said the credit for CalVet’s drive of excellence reflects the dedication at every level to helping other California veterans.
Each year, the Homes are inspected by the U.S. Department of Veterans Affairs, MediCare, the California Department of Public Health, and the California Department of Social Services. Each has its own sets of rules, and the VA’s alone includes hundreds of pages. Bucci set about making them easier for the Homes’ administrators and staffs to decipher and, thus, meet or surpass.
“We needed a standardization of business and clinical operations,” Imbasciani said. “He (Bucci) distilled through the myriad of rules and regulations to teach them to the clinical staff at all eight Homes. He did it so well that we went from two stars to five.”
Six of the eight Veterans Homes of California have been opened since 2000. Yountville, which opened in 1884, is expected to get a new $320 million, 240-bed SNF to replace antiquated Holderman building in the not-too-distant future.
“All six SNFs passed their MediCare inspections and all eight are USDVA certified,” Bucci said. In fact, he said, four of them – Redding, Yountville, Barstow and Fresno –are ranked in the top 10 percent among the 15,000 SNFs nationally. They were joined by Chula Vista in the nation’s top 20 percent. “That is really, really rare for government-operated facilities,” Bucci said.
While Imbasciani credits Bucci for streamlining the process, Bucci attributes the improvements to Imbasciani’s experience and understanding of hospitals, and of medical care in general.
“He’s taken us from the bottom to the top,” Bucci said. “Doc has made this into a healthcare company.”
Indeed, having a doctor in the house is making a huge difference, and the proof is in the ratings.