WEST LAFAYETTTE, Ind. (AP) - In a wooded enclave just north of West Lafayette, Indiana Veterans' Home gives the appearance of a neat and orderly military base.
The campus has been home to Indiana's veterans since 1896, when individual counties had a direct role in caring for their war-bruised and battered Civil War veterans.
It's a nursing home where Memorial Day, Veterans Day and Pearl Harbor Remembrance Day are solemnized, not forgotten. Where a small army of medical, nursing, dining and administrative staff attend the residents night and day, whether they need only occasional help or constant care.
But as nursing homes go, there's less here than meets the eye. Despite its large staff, ample grounds and hale camaraderie among veterans, the quality of care at Indiana Veterans' Home has consistently ranked near the bottom of Medicare's nursing home ranking system - two stars out of five possible.
The low rankings have been accompanied by turnover of top administrators.
In January, a new permanent superintendent - one with no proven track record of running a long-term care facility but who does have years of nursing, military and administrative experience, and enthusiasm for the job - took office.
Linda Sharp, 50, an Army reservist and registered nurse, is confident in her ability to give fellow veterans the care they deserve.
Whether her leadership will lead to measurable improvement in the Indiana Veterans' Home Medicare ratings - among the lowest among the county's nursing homes and nation's veterans homes - remains to be seen, but her presence already has made a favorable impact on some residents and some outside observers.
Part of that is due to her hands-on management style. She gets out of the office frequently to talk informally with residents and staff. Her outgoing manner is a sharp contrast to the previous superintendent - not counting two interims - who resigned in 2012 after coming under fire from residents and health care officials, who found him uncommunicative and at times unwilling to listen to criticism aimed at improving care.
"She's not a stranger, and it'll be so much nicer for the residents to see her around," Lois Grond said. She has lived at the home for more than five years; her sister, also a veteran's spouse, lives there, too.
Grond said Sharp doesn't just shake hands and move on.
"She listens. It's not in one ear and out the other. There is no one more caring for the whole facility. She knows people already."
There are many residents to get to know, although there's room for more. Currently, 240 veterans or spouses live at the home, which is at 57 percent of total capacity. In early 2012, the population was 260.
In the mid-1970s, as many as 550 residents lived there, filling buildings that have since been razed due to lack of use or age.
The home has 337 comprehensive care beds in addition to 80 beds in the domiciliary unit, where residents care for themselves. While the domiciliary unit is near capacity, just 51 percent of the comprehensive care beds were filled as of Feb. 5, according to a state report.
Getting more residents to choose Indiana Veterans' Home rather than nursing facilities in their hometowns is another challenge Sharp faces as the chief administrator. And it may not be easy to overcome given the age, size and location of the home.
Bradford Slagle, a Michigan state veterans home administrator and president of the National Association of State Veterans Homes, said some states, such as Wisconsin, are building smaller homes in locations where families can more easily visit their veterans "and they are filling them."
Ray Miller, 91, uses his walker to move around. A pilot who served in World War II, he calls himself a "newcomer," having lived at the home about two years.
He said his family had reservations about his move from Indianapolis, but Miller persisted, saying he was impressed with the home. His family finally agreed, he said.
"It's the best thing to happen," Miller said of his move. "They can come and go and not worry about me. It's been a blessing for us."
Like Grond, Miller is satisfied with the quality of care he's received. He likes Sharp's outgoing manner and believes she'll be a good leader.
"She's a person that pays attention to detail," he said.
State Sen. Ron Alting, R-Lafayette, is familiar with the home's rocky past. An elected leader who's closely followed the developments at the home, he's received plenty of feedback about how previous administrators were unwilling to listen to residents' concerns.
Alting said he's pleased with Sharp's appointment and said he's already heard positive comments from residents, staff and family members.
Among the challenges Sharp faces, perhaps the most difficult will be to improve the Medicare rating, which is based on surveys - usually done once a year - by state health inspectors. The ratings are based on an average of three inspections, so incremental improvements in performance don't show up immediately.
"As with any health care facility, there is also room for improvement," Sharp said. "We will continue to focus on providing the best possible care for our veterans and their spouses.
"I'm pleased that we rank highly in important areas, such as immunizations," she added.
Slagle, a nonveteran administrator, said the pressure on nursing home administrators to meet myriad state and federal regulations is intense. The larger the home, the easier it is to stumble and fall, he said.
"If you have 200 veterans, you have 200 opportunities for failure every minute of the day." He said he wasn't familiar with the conditions at Indiana Veterans' Home.
Sharp inherits a home with a tarnished reputation. While the previous full-time superintendent focused on improving the home's infrastructure, health care slipped. State inspections revealed numerous deficiencies that jeopardized residents' health, such as missed medications and infections that went untreated.
The home's latest annual inspection, in March 2013, showed signs of progress, with fewer and less-serious deficiencies.
Another challenge Sharp faces is the perception that she took a shortcut to getting her health care facility administrator's license. While most long-term care administrators get a license after formal training and a rigorous licensing exam, Sharp did not.
Instead, she obtained her license late in 2013 through a relatively new waiver option that credits military experience in lieu of traditional licensing requirements.
Sharp said she would have preferred to go back to college for a health facility administrator's license, but the timing never worked out.
In 2012, while Sharp was working as a nurse at Indiana Veterans' Home, the Indiana Professional Licensing Agency began granting military waivers for the first time.
That doesn't mean a military experience waiver is automatically given, said Sue Swayze, communications director for the state licensing agency. Requirements for licensing are up to individual licensing boards.
"That happens hardly at all," she said of the military option. "It's very rare."
Sharp's application went before the Indiana State Board of Health Facility Administrators on Nov. 19. Board members voted unanimously to waive the administrator-in-training exam as well as the National Association of Long Term Care Administrator Boards exam.
Sharp enlisted in the U.S. Army in 1982 and spent three years of active duty as a combat medic. She then earned a nursing degree from Indiana University and transferred to the U.S. Army Reserves, where she continued as a combat medic, corpsman, nurse, executive officer and ultimately commander of the 801st Combat Support Hospital, B Company.
She also has worked as a nurse and nursing supervisor at various facilities in the state, including Logansport State Hospital, a mental health facility.
She joined Indiana Veterans' Home as a charge nurse in 2010, then was promoted to nursing unit manager in March 2012. She was named director of nursing in 2013. Her appointment as superintendent became effective Jan. 12. She continues to serve in the Army Reserves.
Despite her lack of formal training or experience running a long-term health care facility, Sharp believes her military background and experience as a nursing administrator have positioned her well.
"Serving as the commander of a combat support hospital has given me a broad foundation to lead a diverse group of people in a complex health care organization," she said. "The military molded me."
Andrea Smothers, ombudsman for Area IV Agency on Aging and Community Action Program, fields complaints about care at nursing homes in Tippecanoe and surrounding counties. Familiar with the darker days of the home's past, she said she's noticed improvements in the past year. She called Sharp "very patient focused."
Smothers said 2013 saw a marked decrease in complaints lodged by residents or residents' families. She said a reduction in staff turnover, which was quite high under the previous permanent superintendent, is helping.
For a resident living in a nursing facility, there are three shifts of caregivers per day, meaning up to 21 different people caring for one resident in a week, Smothers said. And if caregivers don't get to know a resident, they can't know what is abnormal.
"That's not providing quality care," Smothers said. "Things aren't caught early, and (that) impacts overall health."
Sharp said that when she took over as interim and then full-time director of nursing in 2013, reducing staff turnover and increasing training were her priorities.
One change aimed at staff retention is a program that enables new employees to become certified nurse aides while working at the home. New hires spend two weeks in the classroom, then go out onto the floor, Sharp said.
They are paid during training and tested by Ivy Tech Community College, so their training is universal, Sharp said, and they are familiar with standards of care at the home from the start.
Currently, there are about 540 employees at the home, said Melissa Templeton, marketing director. That includes 250 full-time state employees; 140 are full-time on the nursing staff. The remainder are contracted employees who provide housekeeping, security, nursing services, and other services.
The resident population has declined in recent years. The number of residents in certified comprehensive care beds has decreased from 224 in 2009 to 179 in 2013, according to state reports.
Sharp said she would like to reverse that trend. Part of the challenge, in addition to improving the quality of care, is responding to the changing veteran population.
The population of World War II veterans that once formed the bulk of residents at the nation's veterans homes is rapidly declining. Potential new residents are younger, with problems different than their older counterparts, such as post-traumatic stress disorder and homelessness, according to Randy Fairchild, Tippecanoe County veterans service officer.
Fairchild, too, is concerned about the decline in population at Indiana Veterans' Home. If the population were to continue to slide, the facility could be in danger of closing.
Indiana Veterans' Home is the only Indiana long-term care facility dedicated to veterans care. It's a unique place where veterans can rub elbows with other veterans on a daily basis.
"They can tell war stories. It's that atmosphere of being with other veterans," Fairchild said.
Sharp is aware of the needs of the younger population of veterans, in particular those who are temporarily homeless and just need to get back on their feet. For a homeless veteran, the goal is to reintegrate him into the community as much as possible.
"We want to help them set goals and meet those goals," she said. That can include making connections with veterans organizations in their hometowns or simply giving veterans dishes and linens for their new homes. Some veterans show up with just a suitcase, Sharp said.
Sharp said local organizations have already expressed interest in programs aimed at helping younger veterans. She hopes to attract younger veterans and show them the home is more than nursing care.
"We want to help them get back on their feet so they think, 'Gosh, I'm not on my own,' " Sharp said.
Improving the Medicare rating, reversing the decline in population, reducing staff turnover and meeting the needs of younger veterans are all challenges Sharp faces as she starts her first year - and she's embraced them.
"This is the place to be."
Information from: Journal and Courier, http://www.jconline.com