Minnesota Veterans Homes

1
Minnesota Veterans Homes

2
MVH History1983 to Present Day

• Tom Mullon
• 1983 1986
• 1987 1988
• 1996 2000
• 2000 2003

3
MVH History1983 to Present Day contd.

• Commissioner Clark Dyrud
• Employee history
• VA Benefits and MVH Homes
• Department of Veterans Affairs and MVH
• 2007 legislative changes and impact
• Board membership
• Ex-Officio membership
• Executive Director

4
MVH History1983 to Present Day contd.

• Dan Williams
• Organization and governance
• Operations and management
• Chronicles and turnaround
• Current state
• Outlook

5
MVH History1983 to Present Day contd.

• Dan Williams
• Organization and governance
• Structure
• Oversight
• Governance
• Operational Structure
• Operations
• Management and Leadership

6
Minnesota Veterans HomesStructure
Governor
Legislature
Board of Directors
State Agencies
Executive Director
U. S. Veterans Affairs
MN Department of Health
MVH Fergus Falls
Board Office
MVH - Hastings
MVH - Luverne
MVH - Minneapolis
MVH Silver Bay
7
Minnesota Veterans HomesOversight
Governor

• Governance
• Appointments
• Policy and Administration
• Statutes and Laws
• Compliance

Legislature
Board of Directors

• Legislative Oversight
• Confirmation
• Budget Appropriations
• Statutes and Laws

State Agencies
Executive Director
Board Office
Homes
8
Veterans Homes Board Governance

• Since 1988, the Minnesota Veterans Homes have
  been governed by the Minnesota Veterans Home
  Board.
• Board of Directors and Chairman appointed by the
  Governor
• Confirmed by the State Senate
• Vice Chair elected by the Board
• Committee assignments by the Chairman
• Responsible for the agency (Board office and five
  homes)
• Strategic direction for the agency
• Hiring and supervision of agency Executive
  Director
• Hiring of Home Administrators (Supervised by
  Executive Director)
• Budget approval
• Management objective and performance measurements
• Compliance (Statute, Law, Regulatory and
  Quality)
• Legislative interaction (As needed)
• Unique activities since July 2005 (No change in
  statute or scope)
• Minneapolis management and Citations
• Board office

9
Minnesota Veterans HomesStructure
Board of Directors

• Governance
• Strategic objectives
• Fiscal oversight
• Hiring
• - Executive Director
• - Administrators

State Agencies
Executive Director

• Advice
• Support
• Board Agency Resources

• Agency General Executive

U. S. Veterans Affairs
MN Department of Health

• Compliance
• Assessment and Monitoring
• Enforcement
• Per Diem

• Compliance
• Assessment and Monitoring
• Enforcement

MVH Homes
Board Office

• Finance / Business
• Nursing
• Dietary
• Activities
• Maintenance

• Finance
• Human Resources
• Legal
• Information Technology
• Legislative / PR

10
Veterans Homes Board BOARD MEMBERS

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

11
MVH History1983 to Present Day contd.

• Dan Williams
• Organization and governance
• Operations and management
• Chronicles and turnaround
• Current state
• Outlook

12
Veterans Homes Board Ex-Officio Board Members

• Clark Dyrud, Commissioner MNVA
• Lyle Koenen, MN House (2007 House appointment)
• Jim Vickerman, MN Senate

13
Veterans Homes Board Statue Experience and
Service

• The Board of Directors consists of nine voting
  members appointed for four year terms.
• Experience in policy formulation.
• Professional experience in health care.
• At least five must be members of a
  congressionally chartered veterans organization
  or their auxiliaries.
• Three non-voting Ex-officio members
• Commissioner of Veterans Affairs
• House designee
• Senate designee

14
Veterans Homes Board Statue - Hiring

• The Board appoints an executive director. The
  Executive Director shall serve in the
  unclassified position at the pleasure of the
  Board.
• The Board hires home Administrators who serves at
  pleasure of the Board and functions under the
  direct supervision of the Executive Director

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Minnesota Veterans HomesOperations
Board of Directors
State Agencies
Executive Director
U. S. Veterans Affairs
MN Department of Health

• Finance / Business
• Nursing
• Dietary
• Activities
• Maintenance

• Finance / Business
• Nursing
• Dietary
• Activities
• Maintenance

MVH Hastings Administrator
MVH Fergus Falls Administrator

• Finance / Business
• Nursing
• Dietary
• Activities
• Maintenance

• Finance / Business
• Nursing
• Dietary
• Activities
• Maintenance

MVH Minneapolis Administrator
MVH Luverne Administrator

• Assistant Administrators

• Finance / Business
• Nursing
• Dietary
• Activities
• Maintenance

• Finance
• Human Resources
• Legal
• Information Technology
• Legislative / PR
• Quality Assurance

MVH Silver Bay Administrator
Board Office
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Veterans Homes Board Agency Leadership Team

• 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
• Transition Team (August 2006 Present / meet _at_
  IED request)
• IED Cox
• Administrator Barrows
• Chairman Johnson
• Vice Chair Williams Chairs designee
• Impact of interim and agency transition

17
MVH History1983 to Present Day contd.

• Dan Williams
• Organization and governance
• Operations and management
• Chronicles and turnaround
• Current state
• Outlook

18
MVH History1983 to Present Day contd.

• Dan Williams
• Chronicles and turnaround
• The need for fiscal transparency (Finance
  Committee)
• The need for operational transparency and
  accountability (Special Review Committee)
• The need for quality of care transparency,
  performance and indicators (Quality Committee
  Ex-Officio Member from the Ombudsman's office)
• The response to varied and sundry public calls
• Turnover at Minneapolis and the Board Office
• Board transition and temporary activities

19
MVH History1983 to Present Day contd.

• Dan Williams
• Organization and governance
• Operations and management
• Chronicles and turnaround
• Current state
• Outlook

20
MVH History1983 to Present Day contd.

• Dan Williams
• Organization and governance
• Operations and management
• Chronicles and turnaround
• Current state
• Outlook

21
Veterans Homes Board Admissions criteria

• Honorably Discharged Veterans
• 181 Consecutive Days on Active Duty
• Minnesota Resident (or had service credited to
  Minnesota / Residency at least 1 day)
• Spouses of eligible Veterans over 55 years of age
  and reside in the state.
• All applicants must demonstrate medical need

22
Veterans Homes Board Legislative Process and
Issues

• Budget appropriations
• Statutes
• Response
• Staffing, updates and communications

23
Minnesota Veterans Homes Funding

• The Minnesota Veterans Home funding sources
• 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

24
MVH - Hastings Connie Ball, Interim Administrator

• Management Team
• Budget
• Current Staffing

25
MVH - Silver Bay Mike Bond, Administrator

• Management Team
• Budget
• Current Staffing

26
MVH - Luverne Pam Barrows, Administrator 

• Management Team
• Budget
• Current Staffing

27
MVH - Fergus FallsJon Skillingstad, Administrator

• Management Team
• Budget
• Current Staffing

28
MVH - Minneapolis Carol Gilbertson, Interim
Administrator

• Management Team
• Budget
• Current Staffing
• Open Assistant
• Possible Assistant (DON)

29
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

30
MVH-Minneapolis MDH Skilled Survey Results

• 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

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MVH-Minneapolis MDH Skilled Survey Results

• 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

32
MVH-Minneapolis MDH Skilled Survey Results

• 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

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MVH-Minneapolis DVA Skilled Survey Results

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

34
MVH-Minneapolis DVA Skilled Survey Results

• 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 - Common Entry Point (CEP)

35
MVH-Minneapolis Current Focus

• Primary areas being addressed include
• Education and training at all levels
• Implementation of falls prevention program
• Addressing incontinence issues
• Compliance with care planning
• Enhancing range of motions assessments
• Enhancing skin integrity assessments
• Correcting medication errors

36
MVH-Minneapolis Steps taken
Heath Dimensions Group - Focused Mock
Surveys Heath Dimensions Group - Current
engagement Department of Health New oversight
role Performance - Plans of correction Deferred
admissions Education and compliance Increased
monitoring Enhanced communication Team
Building Redesign of Quality Management Team
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Minnesota Veterans Homes

• Board and Committee meeting minutes - summary
• Board governance
• Agency governance
• Agency management
• Minneapolis governance
• Minneapolis management
• Other Homes Governance and management

38
Minnesota Veterans Homes

• Governance and management within the homes and
  agency
• Leadership past and present Organization chart
• Chains of command and delegations of authority
• Succession planning - Deputy Executive Director
  position
• Key management / leadership objectives
• Boards vision and voice
• Fiscal management (budgeting process and
  performance)

39
Minnesota Veterans Homes

• VA per diem (process, amounts and items covered)
• Statues covering MVHB
• Admissions process (residency requirements at
  least 1-day)
• Role of the VA, (Minneapolis, South Dakota, North
  Dakota, Washington, DC), and its relationship to
  the agency and specific homes
• Role of the Minnesota Department of Health and
  other state agencies (AG, Doer, Admin, Finance,
  etc.)

40
Minnesota Veterans Homes

• Other Considerations
• Assisted Living
• Adult Day Health
• Increased VSO Participation
• Volunteer and Management of Indirect Costs
• Resident and Family satisfaction
• Survey readiness and citation reduction

41
Minnesota Veterans Homes

• Wrap-up
• Types of care
• Quality Management
• Quality indicators
• Performance indicators
• Compliance (regulatory / oversight / law /
  statute)
• Day-in-the-life of a resident
• Admissions to end-of-life / or discharge
• Discharge is more common for VA hospitals not
  Veterans Homes