Minnesota Veterans Homes

1
Minnesota Veterans Homes

2
Mission of the Veterans Homes Board

• The mission of the Veterans Homes Board is
  to oversee and guarantee high-quality health care
  for veterans and dependents in its care. This
  commitment is demonstrated by
• Targeting services to veterans with special
  needs.
• Supporting research and education in geriatrics
  and long-term care.
• Providing a therapeutic environment that
  encourages resident independence, respects
  individuality and promotes self-worth and well
  being.
• Continuous evaluation of care and services to be
  responsive to changing needs.
• Managing the Veterans Homes with honesty,
  integrity, and cost effectiveness.
• Recognizing employees for their contributions.
• Working cooperatively with the medical
  communities.

3
Veterans Homes Board Governance

• Since 1988, the Minnesota Veterans Homes have
  been governed by the Minnesota Veterans Home
  Board.
• Prior to 1988, the Minnesota Department of
  Veterans Affairs had responsibility of the homes

4
BOARD MEMBERS

• Jeff L. Johnson Chairman (Alpha)
• Dan Williams Vice Chair (Vadnais Heights)
• Dean Ascheman (Rosemount)
• Robert Erickson (Bloomington)
• Lawrence Greenberg (St. Louis Park)
• Vi Wagoner (Lake Elmo)
• William Wroolie, Jr. (Brainerd)
• William Tendle, Jr. (Plymouth)
• Byron Opstad (Bloomington)

5
Additional Board Members Staff

• Commissioner Clark Dyrud, Ex-Officio
• Rep. Lyle Koenen, Ex-Officio
• Sen. Jim Vickerman, Ex-Officio
• Charles Chip Cox, Interim Executive Director
• Mike Bond, Administrator, Silver Bay
• Carol Gilbertson, Interim Administrator,
  Minneapolis
• Jon Skillingstad, Administrator, Fergus Falls
• Connie Ball, Interim Administrator, Hastings
• Pam Barrows, Administrator, Luverne

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Board of Directors Statue

• The Board of Directors consists of nine voting
  members that are appointed by the Governor for a
  term of four years.
• The members of the Board of Directors have
  experience in policy formulation with
  professional experience in health care.
• At least five members on the Board of Directors
  must be members of a congressionally chartered
  veterans organization or their auxiliaries

7
Board of Directors Statue

• The commissioner of Veterans Affairs shall serve
  as an ex officio, non voting member of the Board
• From each house of the legislature, the chair of
  the committee that deals with veteran affairs
  shall serve as an ex officio, non voting member
  of the Board.
• The Board appoints an executive director. The
  executive director shall serve in the
  unclassified position at the pleasure of the
  Board.

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Admissions criteria

• Honorably Discharged Veterans
• 181 Consecutive Days on Active Duty
• Minnesota Resident (or had service credited to
  Minnesota)
• Spouses of eligible Veterans over 55 years of age
  and reside in the state.
• All applicants must demonstrate medical need

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Services at MVH Homes

• Skilled Nursing 24/7
• Special Care Units - Dementia/Alzheimer's
• Domiciliary (Board Care)
• Physical Therapy
• Occupational Therapy
• Speech Therapy
• Chiropractic (w/Dr.'s order)
• Recreational Therapy
• Dental
• Podiatry
• Optometry exams
• Medical Care by Attending Physicians

• Hospice
• Social Services
• Mental Health Services
• Work Therapy
• Drug Alcohol Counseling
• Transitional care
• Spiritual Care
• Volunteer Programs
• VA CBOC (Fergus Falls)
• Education Affiliations
• Geriatric Research Programs with VA
• Pharmacy Service

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MVH Legislative Initiatives

• Change of language to allow the Veterans Homes to
  offer a free meal to staff assigned to work
  overtime.
• Change the language to allow the use of 2.2
  million dollars for R B needs rather than Asset
  Preservation.
• Changing requirements of the Chairman of the
  Board, Ex-officio members and the Executive
  Director.
• Budget for FY 08 09

11
Minnesota Veterans Home Funding

• The Minnesota Veterans Home sources for funding
  are
• State Appropriation 49.6
• Resident Payments 22.8
• VAMC Per Diems 21.1
• 67.71 per resident day for skilled care
• 31.30 per resident day for domiciliary care
• Leases and others 6.5

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Hastings Veterans HomeConnie Ball, Interim
Administrator

• Established 1978
• 200 domiciliary beds
• 128 acre campus
• Vocational Rehabilitation
• Substance Abuse Aftercare

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Patient Characteristics Domiciliary

• Average age 57
• Ages range from 27 to 93 years old
• Primarily male
• Majority of residents are Vietnam veterans, but
  also have Iraq, Gulf, WWII, and Korean veterans
• Top Three Diagnosis
• Major Depressive Disorder/Depression
• Hypertension
• Hyperlipidemia
• 85 of residents have a mental health diagnosis

14
MVH-Hastings Domiciliary

• Occupancy rate for
• 2005 was 86
• 2006 was 94
• 2007 year to date 91. Currently no waiting
  list.
• Average Case Mix/Behaviors for
• 2006 were 1.11 and 1.55 respectively
• 2007 year to date are 1.14 and 1.59 respectively
• Average number of medications per resident is
  eight
• Average number of medical appointments per week
  at this facility is 131

15
MVH-Hastings Domiciliary

• Currently staffed with 101 full and part time
  employees
• Average length of service for employees is 10.74
  years
• Annual Budget is 7.2 million dollars
• Daily Cost of Care for FY 06 was 98.98
• Daily Cost of Care for FY 07 is 106.85

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MVH-Hastings Domiciliary Survey Results

• Health Department
• Zero citations in 2003
• Zero citations in 2005
• U.S. Department of Veterans Affairs
• Two partially met with all other substantially
  met in 2006
• All substantially met in 2007

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MVH-Hastings Special Programs

• DOM Plus, which was developed to bridge the gap
  between domiciliary and skilled care levels.
  This enables the residents to maintain their
  independence for as long as possible.
• A Supportive Housing Program is currently in
  place in the Hastings community. A house was
  purchased with HUD funding, with room for five
  tenants.
• We have plans for a 30-bed supportive housing
  unit on the campus of MVH-Hastings. The design
  for this concept has been completed.

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Silver Bay Veterans HomeMike Bond,
Administrator

• Established 1991
• 89 skilled beds
• Dementia unit (25 beds)
• 50 miles N.E. of Duluth

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Patient Characteristics Skilled Care

• Average age 80
• Ages range from 50 to 95 years old
• Primarily male
• Majority of residents are WW II veterans
• Top Three Diagnosis
• Hypertension
• Depression
• Dementia with Behaviors
• 64 of residents have a mental health diagnosis

20
MVH-Silver Bay Skilled Care

• Occupancy rate for FY 05 and 06 was 87
• Year to date occupancy rate for FY 07 is 91
• Currently waiting list is 11 active and 376
  inactive
• Currently 75 veterans and 10 spouses reside at
  the facility
• Average Case Mix is 2.57
• Average Case Mix for Behaviors is 2.01

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MVH-Silver Bay Skilled Care

• Annual Budget is 7.6 million dollars
• Daily Cost of Care for FY 06 was 247.62
• Daily Cost of Care for FY 07 is 250.66

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MVH-Silver Bay Skilled
Survey Results

• Health Department
• 4 citations in in FY 05
• 3 citations in in FY 06
• U.S. Department of Veterans Affairs
• 3 citations in FY 05
• 5 citations in FY 06

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MVH-Silver Bay Special Programs

• MVH- Silver Bay has established falls and
  behavior teams which has resulted in
• reduced falls and injury from falls dramatically.
• reduced use of psychoactive medication

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MVH-Silver Bay Skilled Care

• Proposed facility expansion is for a clinical
  upgrade to include
• hospice rooms
• dining areas
• a chapel
• an additional dayroom
• increased recreation, therapy and storage space

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Luverne Veterans HomePam Barrows,
Administrator 

• Established 1994
• New construction local and VA grant funding
• 85 skilled beds
• Wander unit (dementia)
• 35 miles from Sioux Falls

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Patient Characteristics Skilled Care

• Average age 80
• Ages range from 50 to 94 years old
• Primarily male
• Majority of residents are WW II veterans
• Top Three Diagnosis
• Alzheimers Disease
• Dementia
• Hemiplegia/Stroke
• 49 of residents have a mental health diagnosis

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MVH-Luverne Skilled Care

• Occupancy rate for the past 2 years is 98
• Currently 74 veterans and 11 spouses reside at
  the facility
• Currently waiting list is 60 active and 376
  inactive
• Average Case Mix is 2.7 with dependency in 7-8
  key activities of daily living
• Average Case Mix for Behaviors is 1.98

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MVH-Luverne Skilled Care

• Annual Budget is 7.8 million dollars.
• Daily Cost of Care for FY 06 was 223.26
• Daily Cost of Care for FY 07 is 232.77

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MVH-Luverne Skilled Care Survey Results

• Health Department
• Zero citations in 2005
• Zero citations in 2006
• U.S. Department of Veterans Affairs
• All standards substantially met for 2005
• All standards substantially met for 2006

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MVH-Luverne Special Programs

• MVH-Luverne adopted the Eden Philosophy several
  years ago and continues on the culture change
  journey.
• Several staff members have been trained in the
  Eden Philosophy and are Eden Associates.
• The Home is divided into two communities
• the Red Wing is for residents that are more
  cognitively independent.
• the Green Wing is for residents requiring more
  cognitive support.
• Construction of a new Dementia Dayroom addition
  is planned to start June 1, 2007.

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Fergus Falls Veterans HomeJon Skillingstad,
Administrator

• Established 1997
• New construction - Local and VA Grant Funding
• 85 skilled beds
• CBOC within complex

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Patient Characteristics Skilled Care

• Average age 80
• Ages range from 52 to 93 years old
• Primarily male
• Majority of residents are WW II veterans
• Top Three Diagnosis
• Dementia
• Cerebral Vascular Accident
• Parkinson's
• 75 of residents have a mental health diagnosis

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MVH-Fergus Falls Skilled Care

• Occupancy rate for the past 2 years is 99.6
• Currently 74 veterans and 11 spouses reside at
  the facility
• Currently waiting list is 73 active and 288
  inactive.
• Average Case Mix is 2.69 with dependency in 7-8
  key activities of daily living.
• Average Case Mix for Behaviors is 1.29

34
MVH-Fergus Falls Skilled Care

• Annual Budget is 7.6 million dollars.
• Daily Cost of Care for FY 06 was 209.89
• Daily Cost of Care for FY 07 is 225.71

35
MVH-Fergus Falls Skilled Care Survey Results

• Health Department
• 2 citations in in FY 05
• 2 citations in in FY 06
• U.S. Department of Veterans Affairs
• 0 citations in FY 05
• 2 citations in FY 06

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MVH-Fergus Falls Special Programs

• MVH-Fergus Falls is in the middle stages of
  developing full architectural plans for a 21 bed
  special care unit addition. Estimated costs are
  7.4 million.
• This addition is being proposed in order to meet
  demand and to better address the needs of our
  Alzheimer/Dementia population.
• Currently our Alzheimer/Dementia population is
  blended into our facility. This has created
  resident conflict between oriented and
  disoriented residents and has not completely
  addressed our dementia residents special needs.

37
MVH-Fergus Falls Best practices / focuses

• The facility has been involved in teaching others
  at MHHA and national conventions about our
  Nursing Universal Worker concept and our award
  winning Primary Focus Nursing Model of care. It
  has been a very successful approach to care.
• We have been asked by MNOSHA to apply for MNStar
  status because of our highly successful
  ergonomics program.
• As a result of ceiling lift, fast beds, and other
  elements of our ergonomics program MVH-FF injury
  rates have decreased.

38
MVH-Fergus Falls Best practices / focuses

• MVH-FF was first in Minnesota to install full
  room ceiling lifts which required the adaptation
  of the room to allow complete access throughout
  the room. This was the pilot project for the
  state on this program.

39
Minneapolis Veterans Home Carol Gilbertson,
Interim Admin.

• Established 1887
• 341 skilled beds
• 61domiciliary beds
• 18 buildings on 51 acres

40
Patient Characteristics Domiciliary

• Average age 60.
• Ages range from 42 to 85 years old.
• Primarily male
• Majority of residents are Vietnam veterans, but
  also have WWII, and Korean veterans.
• Top Diagnosis
• Major Depressive Disorder/Depression
• Diabetes
• 57 of residents have a mental health diagnosis.

41
MVH-Minneapolis Domiciliary

• Occupancy rate for
• 2005 was 97
• 2006 was 95 in 2006
• 2007 year to date 91. 5 on the waiting list.
• Currently 58 veterans reside at the facility
• Average Case Mix/Behaviors for
• 2007 year to date are 1.03 and .44 respectively.
• Average number of medications per resident is 9.
• Average number of medical appointments per week
  at this facility is 82.

42
MVH-Minneapolis Domiciliary

• Currently staffed with 9 full and part time
  employees.
• Average length of service for employees is 8.66
  years.
• Annual Budget is 5.8 million dollars for
  Domiciliary Care

43
MVH-Minneapolis Domiciliary Survey Results

• Health Department
• 4 citations in 2005
• 7 citations in 2006
• U.S. Department of Veterans Affairs
• All substantially met in 2005
• 8 citations in 2006

44
MVH-Minneapolis Domiciliary Survey Results MDH

• Health Department 2006 - 7 Citations
• Direct Care - 2
• Bed Linens Not Fitting
• Offensive Odors
• Indirect Care 5
• Withdrawal of Funds
• Accommodating Food Habits and Customs
• Courteous Treatment
• Personal Privacy/Grievance Process
• Health Department Resurvey February 27, 2007
• All Citations Cleared

45
MVH-Minneapolis Domiciliary Survey Results VA

• U.S. Department of Veterans Affairs - 8 Citations
  
• Direct Care 2 Citations
• Rehab Therapy Measurable Goals
• Recreation Therapy-Scheduled Activities
• Indirect Care 6 Citations
• Staff Development
• Safety Code Standards
• Life Safety Deficiencies Not Corrected
• Quality Assurance Program-Ongoing Review
• Quality Assurance Program-Annual Re-evaluation
• Respect and Dignity
• Resurvey March 19, 2007
• All Citations Cleared

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Patient Characteristics Skilled Care

• Average age 77.
• Ages range from 53 to 99 years old.
• Primarily male
• Majority of residents are WW II and Korean
  veterans.
• Top Three Diagnosis
• Hypertension
• Depression
• Diabetes
• 94 of residents have a mental health diagnosis.

47
MVH-Minneapolis Skilled Care

• Occupancy rate for 2005 was 99
• For 2006 was 99 in 2006
• 2007 year to date 92.
• Currently 273 veterans and 27 spouses reside at
  the facility
• Currently waiting list is 325 active and 612
  inactive.
• Average Case Mix is 2.7 with dependency in 7-8
  key activities of daily living.
• Average Case Mix for Behaviors is 1.78

48
MVH-Minneapolis Skilled Care

• Annual Budget is 30.5 million dollars for
  Skilled Care
• Currently staffed with 573 full and part time
  employees.
• Average length of service for employees is 8.66
  years.
• Daily Cost of Care for FY 06 was 231.56
• Daily Cost of Care for FY 07 is 250.37

49
MVH-Minneapolis Skilled Survey Results

• Health Department
• 28 citations in 2005
• 26 citations in 2006
• U.S. Department of Veterans Affairs
• 7 citations in 2005
• 33 citations in 2006

50
MVH-Minneapolis Skilled Survey Results MDH

• Health Department 2006 26 citations
• Direct Resident Care 14 Citations
• Adequate / Proper Care
• Range of Motion
• ADLS
• Pressure Ulcers
• Incontinence
• Assistance with Meals/Risk of Choking
• Medication Errors

51
MVH-Minneapolis Skilled Survey Results MDH

• Direct Resident Care (continued) 14 Citations
• Accommodating Food Habits/ Customs/Nutritional
  Status
• Available Recreational Activities
• Bill of Rights/Vulnerable Adults- 6
• Withdrawal of Resident Funds
• Courteous Treatment/Respect/Privacy
• Grievance Process
• Documentation 3
• Care Plans/Assessments
• Information Gathered/Use
• Environmental 3
• Cleanliness/Appearance
• Repair/Housekeeping

52
MVH-Minneapolis Skilled Survey Results MDH

• Resurvey February 20-27, 2007
• Direct Care 7 Re-issued - 3 New Citations
• Medication Errors
• Falls
• Range of Motion
• Dignity and Respect
• Resurvey April 12, 2007
• All Citations Cleared

53
MVH-Minneapolis Skilled Survey Results DVA

• U.S. Department of Veterans Affairs Of the 33
  Citations in
• November 2006.
• 11 were in Direct Care
• Quality Assurance
• ADLS
• Incontinence
• ROM
• Medication Errors
• Storage and Labeling of drugs
• Reporting of Sentinel Events
• Training of Nurses Aides

54
MVH-Minneapolis Skilled Survey Results DVA

• DVA Resurvey February 27, 2007
• 15 Citations Partially Met - 18 Citations
  Fully Met
• Direct Care -3
• Biological/Medication Storage/Food Temps
• Respect and Dignity
• Indirect Care -12
• Staff Development/Falls Program
• Training/Documentation
• Assessments/Shift to Shift Report
• Care Plans
• Reporting CEPs

55
MVH-Minneapolis Focus

• Current primary areas of concern have been
• Falls prevention
• Incontinence issues
• Care planning
• ROM
• Skin integrity
• Medication errors

56
Steps taken at MVH-Minneapolis

Heath Dimensions Group (HDG) Oversight by the
Department of Health Developed POC Deferred
Admissions Training/Teaching Monitoring Focused
Mock Surveys Communication Team Building Redesign
of Quality Management Team
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Veterans making it happen
Support from numerous Veteran organizations
makes many of the things at our homes possible.
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Minnesota Veterans Homes

• Web site..
• http//www.mvh.state.mn.us
• Home Board Office
• 1-877-MVBOARD

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• At the prime of their youth.
• Many men and women left the safety of their
  homes..
• To fight for the cause of freedom in distant
  lands.
• Now in the twilight of their years.
• Many who served once again leave their homes.
• This time fighting the effects of age and
  illness.
• As they persevere to maintain their own freedom.
• We pledge never to forget the sacrifices that
  they
• have made in the past..
• To stand with them in the present..
• And to be here in the future..
• Serving those who served.
• by Shawn Barry

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Thank you...
...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 Lincoln's Second
Inaugural Address, March 4, 1865.