She might still get lost in her new hospital but walking into the freshly renovated outpatient waiting area, Ellen DeGeorge-Smith knows exactly where she is going.
As the new director of the Augusta Department of Veterans Affairs Medical Centers, she sees the key to the centers' future is in packing the waiting rooms with veterans.
And while veterans groups protest an ambitious VA plan to cut expenses and see more veterans, Mrs. DeGeorge-Smith insists it can work.
Mrs. DeGeorge-Smith took over in August for David Whatley, who left at the beginning of the year to go to Houston. Ralph Angelo had been acting director in the interim.
She inherits a budget with no new money for next year and must operate under a controversial nationwide directive known as "30-20-10," for cutting costs by 30 percent while serving 20 percent more patients and earning 10 percent of its revenue from outside sources.
"I personally believe it's a very important change if the VA is going to survive as a health care system," said Mrs. DeGeorge-Smith, who began as a nurse and rose into administration. "We have accountability to the veterans and we have accountability to the taxpayers. I think we can be accountable to both and still provide services and do it in an efficient way."
The key to that will be stretching the same amount of money over more patients and taking into account a proposed 3.6 percent employee pay raise and health care inflation.
"As positions become vacant, we really evaluate the need for that position," she said. "If we do some decent planning, we should be able to manage our budget this year just by controlling how we handle our vacancies, and other ways we spend money and control costs."
That logic has been scoffed at by veterans groups such as the Paralyzed Veterans of America, who are opposing the renomination of the plan's architect, VA Undersecretary for Health Dr. Kenneth Kizer.
"Something is going to give," said Richard Fuller, national legislative director for the Paralyzed Veterans.
"When they start cutting, veterans suffer," said David Vaughn, who serves on the group's national board of directors.
The group has been most concerned about the Spinal Cord Injury units -- Augusta is one of 23 VA hospitals that has the special units -- and how the VA has been over-reporting the resources available there.
In Augusta, for instance, the PVA counted 50 beds available for patients in the unit instead of the 60 reported, and less than half the staff the VA said it had available. Veterans who use the unit have complained about a lack of therapists.
Mrs. DeGeorge-Smith at first was unaware of the staff shortage but after checking acknowledged a shortage that the center is trying to correct.
Groups like the PVA see a more insidious motive in the VA trying to dump expensive long-term care patients, such as those with spinal cord injuries and Alzheimer's and dementia patients, into nursing homes where the care could fall on the state's Medicaid system.
But Mrs. DeGeorge-Smith insists moving to the community setting is done when it is best for the patient.
"The VA is still very much involved in their care," she said. "It's the living environment that's changed, which is hopefully a better environment for them."
The move also allows more patients to come through and puts the emphasis on outpatient care, which is less costly and can provide care to more patients, she said. But it will not mean closing down any units, she said.
"There is no plan to change the level of beds in the Alzheimer's/Dementia (unit)," she said. And, despite stopping short of giving a guarantee, there are no plans to close down the Uptown Division where it is housed, a longstanding fear of veterans in Augusta.
"I am certainly not looking toward closing it," she said. "I have not been told to do that. I certainly do have to look at making it more efficient and providing the most services we can to veterans and that means getting more people through those facilities."
It was a difference situation at her most recent post before Augusta.
While at the Central Iowa Health Care System, she combined some services at VA centers in Des Moines and Knoxville, and eliminated more than 100 positions. She closed an inpatient psychiatric ward and eliminated acute care beds because patient census was declining. That meant laying off 94 people who worked on those wards, she said.
But it is a different situation in Augusta, she said. Instead of a declining number of veterans, the Augusta area has had veterans moving in, and the more veterans that use the VA centers, the more they justify the need to keep the hospital at its present size, Mrs. DeGeorge-Smith said.
"Veterans will support their VA health care system, utilize their VA health care system and demand that their VA health care system be here for them," she said "You have to size the system to fit the needs of the veterans. Here that is not an issue."
What does concern veterans advocates is whether the specialty services they need, and the beds for those who need them, will be there in the future.
"Those types of services are what the VA is supposed to do," Mr. Fuller said. "It's more efficient (now) but you've lost your sense of identity. The cost has won out over the care."
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