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The Bill is Coming Due

Ever looked for a nursing home?

Medicare has this helpful feature on their website called Nursing Home Compare, that allows you to search for Medicare/Medicaid approved nursing homes. You plug in some search criteria (zip code, city, etc.), and up comes a list of facilities that meet your requirements. For each of them, you can check out the quality of the setting (on measures like % of residents given influenza vaccine during last Flu season, for instance), look at the results of recent health and fire safety inspections, examine the staffing levels (# licensed RNs/patient, for instance), and get an overview of the facility (for-profit or not-for-profit, # beds, etc.). You can easily compare multiple facilities, and all in all, it's a pretty good tool for sorting out a lot of data.

Once a person has used this tool to narrow their search, Medicare has a great five page checklist [pdf], that you can use when you are evaluating a facility. It's full of yes and no questions, with spaces for comments and other notes as well. Take one to each place that you are interested in, ask your questions and make your notes, then compare the results once you're done.

As a military facility, Walter Reed Army Medical Center is obviously not in this Medicare database, which is probably just as well for its leadership, given the incredible reporting by Dana Priest and Anne Hull, starting with a bombshell piece this past Sunday.

The common perception of Walter Reed is of a surgical hospital that shines as the crown jewel of military medicine. But 5 1/2 years of sustained combat have transformed the venerable 113-acre institution into something else entirely — a holding ground for physically and psychologically damaged outpatients. Almost 700 of them — the majority soldiers, with some Marines — have been released from hospital beds but still need treatment or are awaiting bureaucratic decisions before being discharged or returned to active duty.

They suffer from brain injuries, severed arms and legs, organ and back damage, and various degrees of post-traumatic stress. Their legions have grown so exponentially — they outnumber hospital patients at Walter Reed 17 to 1 — that they take up every available bed on post and spill into dozens of nearby hotels and apartments leased by the Army. The average stay is 10 months, but some have been stuck there for as long as two years.

Not all of the quarters are as bleak as Duncan's, but the despair of Building 18 symbolizes a larger problem in Walter Reed's treatment of the wounded, according to dozens of soldiers, family members, veterans aid groups, and current and former Walter Reed staff members interviewed by two Washington Post reporters, who spent more than four months visiting the outpatient world without the knowledge or permission of Walter Reed officials. Many agreed to be quoted by name; others said they feared Army retribution if they complained publicly.

While the hospital is a place of scrubbed-down order and daily miracles, with medical advances saving more soldiers than ever, the outpatients in the Other Walter Reed encounter a messy bureaucratic battlefield nearly as chaotic as the real battlefields they faced overseas.

Mold on the walls, leaky pipes, lost paperwork, overworked caseworkers, poor coordination of resources for families, lack of translators, poor training for staff, suicides, uncaring supervisors . . . all in all, it's not a pretty picture. And if you're into pictures, check out the photo gallery by Michel du Cille and Kate Robertson that goes with the Priest and Hull stories.

I have a friend who inspects nursing homes for a living, assessing their facilities and standards of care. I'm almost afraid to call her and ask what she thinks of Walter Reed. She'd have a lot to say, I'm sure, but it would probably boil down to one thing: "If this weren't a military facility, it would have been shut down for endangering its patients."

That was Sunday's piece. Yesterday, they reported that Building 18, which played a leading role in Sunday's page A1 story, is now being dealt with. Top to bottom inspections have suddenly been made of every room, and the problems of that building are beginning to be addressed.

But that's one building. The harder issues will be rebuilding trust with out-patients and families who have long lost it, creating and maintaining a records system to handle the case load, hiring and training staff to meet the medical needs, and so much, much more.

And that's just one hospital base. I've got a hunch that Walter Reed isn't the only place that's been shattered and overwhelmed by "5 1/2 years of sustained combat." 

Since the party who gave us this war has been so uninterested in any kind of accountability, it's no wonder this kind of thing has taken place. No one wants to admit how much of a toll this war has taken, and no one wants to admit that we are ill-equipped to care for the wounded and their families. If the Decider-In-Chief has his Official Smiley Face on, woe be unto the staff member of a 113 year old military hospital who says "Uh, boss? About those wounded vets . . . they're really starting to pile up around here. We could sure use some more resources to deal with it."

In yesterday's briefing, Tony Snow was asked about the Walter Reed stories in the Washington Post. According to today's story by Priest and Hull,

Snow said Bush "first learned of the troubling allegations regarding Walter Reed from the stories this weekend in The Washington Post. He is deeply concerned and wants any problems identified and fixed." The spokesman said he did not know why the president, who has visited the facility many times in the past five years, had not heard about these problems before.

(Bush can now find all the Washington Post's WRAMC coverage right here, and so can you.)

Hmmm . . . That "first learned of the troubling allegations" line sounds familiar. Katrina, anyone? No, IIRC that was CNN, not the Post. But I digress . . .

When DC was overrun with military casualties during the Civil War, it gave Abraham Lincoln a clear unvarnished view of the toll a war takes. Bush, I'm afraid, looks at a daily one-page briefing sheet, strolls through the spit-and-polish amputee ward, calls or meets with a few family members to offer condolences, and thinks he understands. But Lincoln and Bush differ in much more than how each looks at war's toll – they have a difference in understanding what war is all about. Lincoln knew what Bush apparently does not: that war isn't ultimately about battles and guns – it is about what happens after the guns fall silent. 

With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.

When you put this mess on top of the military contracting debacle that is Iraq, the result in unconscionable. We've got a helluva long way to go in caring for those who have "borne the battle" and for the survivors left behind by the fallen. "We Support the Troops" is a nice slogan, but without accountability, it's only words.  

And you can bet that the White House and Congress know the words. Today's Priest and Hull piece promises "swift action" and describes lots of VIP visits, special orders, and the like. But what will happen when the publicity fades?

By all means, go and visit the local wounded veterans in your area. Donate to the various relief funds. Volunteer to help out however you can, and share some links in the comments that you've found useful. But don't stop there. Get on the phone and call your distinguished representatives and senators – especially if they are Republicans. Ask why they allowed this to happen through their lack of oversight, and what they're going to do about it now. This isn't going away any time soon, and wishing won't make it disappear.

The bill for this war is coming due, and it's going to be a doozy before it is all over.

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I'm an ordained Lutheran pastor with a passion for language, progressive politics, and the intersection of people's inner sets of ideals and beliefs (aka "faith" to many) and their political actions. I mostly comment around here, but offer a weekly post or two as well. With the role that conservative Christianity plays in the current Republican politics, I believe that progressives ignore the dynamics of religion, religious language, and religiously-inspired actions at our own peril. I am also incensed at what the TheoCons have done to the public impression of Christianity, and don't want their twisted version of it to go unchallenged in the wider world. I'm a midwesterner, now living in the Kansas City area, but also spent ten years living in the SF Bay area. I'm married to a wonderful microbiologist (she's wonderful all the way around, not just at science) and have a great little Kid, for whom I am the primary caretaker these days. I love the discussions around here, especially the combination of humor and seriousness that lets us take on incredibly tough stuff while keeping it all in perspective and treating one another with respect.

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