From the Forum – Armed Forces Retirement Home Bureaucracy?

soldiers home

Armed Forces Retirement Home Bureaucracy?

“My father submitted an application for admission to the Armed Forces Retirement Home (Old Soldiers’ Home) here in Petworth nearly five months ago. He’s qualified under their published admission guidelines, and I paid the Public Affairs office a visit before he initiated the application process to ask for clarification on the one issue that could have disqualified him (he suffers from PTSD as a result of his time in Vietnam, and I asked for clarification on whether or not PTSD is a ‘psychiatric’ condition and would preclude his admission. It is not, and would not, according to one representative.)

He and my mother then visited before he applied for an official tour and an in-person debrief before completing the application. With that background, any questions regarding his qualifications for (and interest in) this home should have been aired before he initiated his application. Apparently, they were not.
The bureaucracy he’s encountered has been staggering, even for a lifelong Washingtonian like me, and a career-Government employee like my Dad.

In late November, he was admitted to the Home during an in-person interview/assessment and was told the admission date would be forthcoming. One month later (after calls to follow-up) he received a form letter stating he was not qualified for admission and his application was rejected. This is insanity.

The COO has had this case in front of him for six weeks. The meeting to discuss appeals was postponed at least twice, and supposedly happened a week or two ago. Nobody is forthcoming with information. My parents’ Congressman has made calls on his behalf. It’s appalling.
The Home falls under the purview of the Department of Defense. The chain of command offers little hope for input on fixing this disparate and broken system. Most worrying of all is that lifelong and/or disabled veterans are being treated in a deplorable manner. At this point, I don’t know that I trust the administration of the Old Soldier’s Home enough to recommend to my dad that he (re)accept admission if offered. I’m much, much more concerned with bringing to light the horrible process unfolding there.

Has anyone else had dealings with the AFRH administration? Specifically the office of the COO? Advice and perspective would be warmly welcomed…”

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16 Comment

  • andy

    Is AFRH supposed to prioritize people with no relatives, etc.? Did they offer some reasoning for non-admission?

    • KSB

      To my knowledge they don’t have a focus on vets with no relatives – admission is open to those who meet the criteria regardless of their family situation (criteria being tied to service, income requirements, and freedom from psychiatric conditions, drugs and alcohol.) No explanation for rejection other than a one-page form letter citing the entrance eligibility requirements, without pointing out which of the criteria he didn’t qualify under. Very confusing.

  • I have not dealt with AFRH specifically, but worked in a nursing home for over 6 years and was at one point a certified assistant living manager in MD. I will preface this by saying that all of the following is based on my knowledge of CMS (centers for Medicare and Medicaid Services) standards and MD regulations. DC’s may be different, and if AFRH does not accept Medicaid or Medicare, they may not be bound by CMS standards.
    Why was your father refused admission? They have to give you a reason for this. Also, which level was he being admitted to? Independent Living, Assisted Living, or Lon Term Care? Each of these levels have different admissions criteria. Psychiatric conditions can be very difficult to deal with in a facility setting in which you have to consider the safety and pyscho-social needs of all patients/residents before that of the person who is seeking admission. I am surprised an admissions coordinator would tell you flat out that a diagnosed psychiatric condition would not be a problem without fully reviewing the medical record first (if this was done, then I get it). If this was the reason he was denied admission, you may have a very difficult time appealing it, especially if he has any sort of violent behavior, criminal record, etc.
    I’m confused because you say he was admitted but that his date of admission would be given at a later date. Did he move in? If he did move in, there is a different way of handling the situation than if he was approved and subsequently rejected. If he was admitted and moved in, there is a very big, long process to go through, and if they did not do this process, you have significant recourse. If he did not move in, or moved in on a contractually temporary basis and was asked to leave at the end of the prescribed period to a safe discharge situation, there is not much you can do.
    I would suggest getting in touch with the local Long Term Care Ombudsman. This is an employee of the city who assists in navigating affairs and complaints against facilities. They will help you to understand why your father has been rejected and advise you on the correct course of action (I will warn you though, they may have perfectly legitimate reasons for rejecting him). Apparently in DC, this is run through AARP, and according to the DOH website, this is their contact info:
    Contact Email:
    [email protected]
    Contact Phone:
    (202) 724-5622

    • There are usually only a few reasons someone will be outright denied admission to a Nursing Home or Assisted Living. 1 – the facility is unable to meet the medical needs of the individual; 2 – the individual does not receive a “level of care” in other words, they are too independent to need assistance with what are known as “Activities of Daily Living” or ADLs; 3 – the person does not meet financial requirements; 4 – the person poses a significant safety risk to others that cannot be mitigated (example, where I used to work, there was a known, convicted violent felon. He was admitted because he was bedridden and unable to actually harm anyone). The people who show you around are trying to sell you. They often have quotas fro the numbers of tours they must provide, the number of contacts they make etc. The general requirements for Admissions Coordinators are a marketing back ground, not a health care back ground. So chances are, they are unqualified to say things like “your father’s condition is fine for admission” not knowing for sure if it is (the language they should use in this case is “your father’s condition may not be a barrier for admission, but we will know more when his history is reviewed”). The fact is, most psychiatric conditions are not barriers for admission, as long as the patient is non-violent, complaint with taking meds (if prescribed), and not a threat. However, according to their website, “a person who has been convicted of a felony or is not free of drug, alcohol, or psychiatric problems shall be ineligible to become a resident of the Retirement Home.” So they may not admit anyone at all with PTSD, and the person or people who told you otherwise may have been flat out wrong. (as an aside, I know for a fact that VA homes do take people with PTSD)
      I think that it’s important to understand that the people who actually make the decision about admissions are generally the nurses who review the applicant’s medical record, interview the applicant, etc. If your father was seeking admission to Independent Living, this may not be the case, but if he needed a Level of Care of LOC – which he would need for AL or LTC – the ultimate decision would come down to a nurse manager, and perhaps the medical director. I know where I worked, the first decision laid with the nurse manager who would sometime work with the social worker. If there was an appeal, then a committee made up of the same nurse manager, the licensed social worker, the medical director, the Director of Nursing (always an advanced nurse with many years of experience), the Risk Manager (often a lawyer), and sometimes the CEO would meet and discuss the case and decide. This is pretty standard practice, and delays in this committee meeting can be for many reasons (like snow – operations comes before meetings), so may not be down to bureaucracy. Or maybe they are. It’s hard to say for sure.
      To me, it sounds like you were sold a bill of goods by the admission staff, and that whatever caused the denial of admissions is too severe to swallow the damage done by admissions and just admit your dad. Whatever that was, it should be in his denial letter. If it’s not, you have a right to know why in order to dispute the denial. If a medical reason was given, you can get second opinions to support your cause. If I were giving you honest guidance as someone who has been on both sides of the admissions table, I would strongly suggest finding a different place where your father can be taken care of an feel at home, or even look into help in the home so that he can age in place versus going into a facility. I realize that this may not be an option, but it is often an option people over look.
      I recognize that this is a scary, daunting, and often overwhelming process. I have been there, both as an employee, and as a family member. I wish you much luck in this process, and I hope you are able to find a suitable option for your father soon.

      • Keep in mind that AFRH has a very specific mandate and unique residency requirements above and beyond facilities open to the general public or even the VA. The OP and their family are absolutely entitled to transparency and a full explanation, but the reason may be something more complex than just the father’s health.

      • KSB

        This is a fantastic synopsis and my complaint basically boils down to the fact that we have been offered no explanation – literally none. The criteria for admission is pretty specific and he checks all the boxes, so the lack of understanding is the foundation for nearly all of this frustration. The right hand is DEFINITELY not talking to the left over there. Thank you for taking the time to share this info and your thoughts!

  • Wow, that must be frustrating. I can’t say I have any experience with this, but here are my thoughts. It looks like the COO is under the “authority, direction and control” of the Secretary of Defense. Perhaps you or your parents’ Congressman (or maybe Senator’s office?) could call SecDef’s office and find out what Undersecretary or Assistant Secretary handles AFRH issues. It may be the Office of Assistant SecDef for Readiness and Force Management (from the organizational flow chart on the AFRH website). It looks like there is also an Ombudsman and an Advisory Council.
    .
    The DoD Inspector General issued a report on the AFRH a few years ago (Report No. DODIG-2014-093). Maybe inquire at the DoD IG’s office? Or the AFRH IG? Your dad deserves an explanation and some guidance. Good luck!

    • It falls under the USD for Personnel and Readiness, and beneath that office ASD for Manpower and Reserve Affairs (new title of R&FM). Most congressional inquires are just addressed to the Secretary then tasked to the appropriate subordinate component, though. I would start with the ombudsman’s office, though, before initiating a congressional inquiry. I wish the OP all the best in getting answers. My father is a Vietnam combat vet as well and still carries visible and invisible scars.

      • KSB

        Many thanks. I’ll start with the ombudsman’s office and work through as much as I can. Both kinds of scars are still so traumatic all these decades later…

    • KSB

      Thank you! Yes, at this point the explanation and guidance would be appreciated. I haven’t seen that report, which surprises me with the amount of digging I’ve done, so THANK YOU again for pointing it out.

  • I’ve volunteered there and you’re right, it’s a mess. Entirely opaque and extremely command-and-control. I’ve heard a lot from the vets I work with but it’s all hearsay, so I’ll just stick with what seems useful.

    1. There are definitely vets with PTSD at AFRH who have been admitted in the past three years so if they try to blame it on that it’s total BS.
    2. The folks I’ve worked with, while frustrated with management, do enjoy the benefits/amenities and the staff I’ve worked with are very caring and dedicated. Management/administrators, not so much, but that’s not necessarily a large part of your life unless you get involved on the committees for resident input.
    3. While the budget (again, hearsay) always seems to be perilous they do have plenty of land they can lease/sell if necessary so I do think it’s a stable place. Worst case scenario, they might cut the golf course.

    Good luck. I can’t begin to imagine how difficult this has been for you.

    • KSB

      Thank you! The kicker is that we’ve spent time at AFRH for events and walking around and really think the quality of life is great there and would be thrilled to have my dad closer. Makes it that much more difficult to swallow this mess.

  • KSB

    Thanks so much to everyone who’s commented – I need to read each of these three more times! A few points of clarification, my dad has been evaluated by PT, OT, Psych, his PCP. He’s been definitively declared free of drugs and alcohol, has no history of psychiatric disorders or violence (which, again, has been documented) and was evaluated by the nurses on-site and told he’d be admitted at an Independent-Plus level (he needs a walker but has been living by himself for years, so he meets the independence test.)
    There was no explanation offered for the refusal of admission – the letter simply regurgitated the eligibility requirements but didn’t say which of those requirements he was deemed ineligible under. I’m just baffled. We’ve worked together as a family to clear every hurdle and provide every possible piece of information that could be helpful. Evaluations, doctor’s appointments, in-person AFRH interviews… it’s been an exhausting five months and the frustration is that we could have (and should have) known 4.5 months ago if he was ineligible for admission.
    We’ve started pursuing the DOD chain of command, and bringing this to the attention of his Congressman (who’s called on his behalf) and other members of Congress who are advocates for disabled veterans.
    Thanks again for the thoughts around this – I’ll pursue as much as I can on his behalf!

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