United States Department of Veterans Affairs
 Health Care
Patients Play Major Role in Transforming Long-term Care
Woman with disabled man in wheelchair
In caring for her Veteran son, Ross, Phoebe Hughes has been a major contributor to the cultural transformation taking place at a VA Community Living Center.

Phoebe Hughes believes Navy medics were able to bring back her son, Ross, from the brink of death for a purpose. In a decade of caring for her severely brain damaged son, Phoebe has been a witness to and a major contributor to the cultural transformation under way in the Community Living Centers of the VA’s Tennessee Valley Healthcare System.

During a fire on a Navy ship, Ross Hughes inhaled enough smoke to kill him, twice. Both times, Navy medics revived him but not before the loss of oxygen to his brain left him permanently disabled.

In another era, Ross may have been placed in a gray room and left to spend his life staring at a blank wall. Not today.

Although he cannot speak, Phoebe knows she communicates with him and that he knows she is there. “He always smiles and looks happy when I walk in.”

The staff at the Murfreesboro VA Community Living Center concurs and shares every happy moment of progress with Phoebe. Dr. Marvin Stubbs, who leads the CLC team, has named Phoebe “Mother of the Year” for her dedication to her son and her willingness to work with the VA to ensure that “we meet his and her needs.”

During the ten years Ross has lived in the Community Living Center (formerly known as a Nursing Home), Dr. Stubbs and his team have implemented dramatic changes in the way residents are treated and helped to launch a significant VA-wide overhaul in the overall approach to care for Veterans.

According to Juan Morales, Director of the Tennessee Valley Healthcare System, “We look at the Cultural Transformation Process as the way of the future for long-term care for Veterans. We are eager to move forward daily in assisting the development of this model by offering a practical understanding of the benefits this patient environment creates for Veterans.”

A unique example of how the VA accommodates the needs of the residents and the requests of their families is the new Dutch door to Ross’ room. Phoebe asked for the half-door after she realized it would allow the staff to check in with her son without having to go in to his room and would also provide the necessary security against unauthorized visitors.

Dutch door to domiciliary room
The Dutch door to Ross’ room, which his mother requested, is one example of how the VA is accommodating the requests of the residents’ families. The door simultaneously provides access and security.

Ross also has his extensive collection of giraffes — his favorite since boyhood — over 25 different versions of the colorful plush toy — decorating his room. Spider Man posters run a close second.

In addition to purchasing a special van for trips to the mall and the movies, Phoebe also worked with the VA to get Ross a specially designed one-of-a-kind wheel chair that fits him perfectly and provides an important level of comfort.

One special service not found in previous “nursing homes” is a fully equipped dental office that makes routine dental visits — an important convenience for the residents of the Community Living Center.

Phoebe is grateful for the attitude of the staff, an essential component of the cultural transformation of the Community Living Center. “They are terrific people. They treat Ross like he’s their kid. I wouldn’t even think about leaving him unless I knew they would take care of him the same way I would. And they do.”

Every three months, the VA staff also participates in the Family Council, which Phoebe chairs. It provides the families of residents an opportunity to share their experiences and exchange candid comments about the needs of their Veteran family member — such as ensuring their clothes are washed regularly and thoroughly. The Council also helped acquire new bedspreads, curtains and pictures for the residents’ rooms.

Phoebe adds that there is also a session without VA staff so “everybody can let it all hang out.”

Director Morales adds, “If you look at our Community Living Centers, it is evident that it is not the conspicuous items making this a better practice. It is the details and nuances which impacts our patients most. It’s important for long-term care patients to play a role in the decision-making process of their day-to-day lives with their best overall interest in mind.”

The transformation is a serious commitment on the part of the entire staff of the VA Tennessee Valley Healthcare System.

Dr. Stubbs addresses the challenge of remaining positive as a provider in Geriatrics and Hospice/Palliative Care, which is a great description of the cultural transformation under way in the VA today: “Geriatrics is a field of medicine which requires the physician to understand that most Geriatrics syndromes and diseases are not curative and that our patients may only have a few remaining moments or opportunities in life to cherish.

“It is imperative that we develop comprehensive individual care plans that address the needs of our patients, including quality, comfort and compassion which are the essential standards when working in the field of Geriatrics. The Cultural Transformation movement allows us to meet these challenges and standards.”

By Hans Petersen, VA Staff Writer

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