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State Veterans Homes “ Back to the Basics ”

State Veterans Homes “ Back to the Basics ”. Valarie Delanko JoAnne Parker Office of Geriatrics & Extended Care (10NC4) Summer Conference 2019. Discussion Topics. SVH Overview VA Form 10-3567 “Staffing Profile” Eligibility Life Safety in a Domiciliary Change in Administration

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State Veterans Homes “ Back to the Basics ”

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  1. State Veterans Homes “Back to the Basics” Valarie Delanko JoAnne Parker Office of Geriatrics & Extended Care (10NC4) Summer Conference 2019

  2. Discussion Topics • SVH Overview • VA Form 10-3567 “Staffing Profile” • Eligibility • Life Safety in a Domiciliary • Change in Administration • Recognition/Certification • Work in a Domiciliary

  3. SVH Program Overview Current SVH Program Structure offering three levels of care: • 156 State Veterans Home Facilities • 149 Nursing Home Care programs (25,238 beds) • 53 Domiciliary Care programs (5678 beds) • 3 Adult Day Health Care programs (109 participant slots)

  4. SVH Program Overview • Federal Regulations: Per Diem Paid to States for Care of Eligible Veterans in State Homes was published in the Federal Register November 28, 2018. • VACO GEC implemented the regulations as part of survey process May 6, 2019. • Electronic link to 38 CFR Part 51: https://www.ecfr.gov/cgi-bin/textidx?tpl=/ecfrbrowse/Title38/38cfr51_main_02.tpl

  5. SVH Survey Overview

  6. VA form 10-3567 Staffing Profile • Staffing Profile form is dated June 2015, expiration date February 2019. The form is in OMB. • VA form 10-3657 available on: http://www.va.gov/vaforms/ • GEC is in a research study on the staffing data. • Regulatory preference is not to identify forms by name or number, makes amendments less tasking. • OMB has authorized collection of information on the 10-3567 and OMB control number is printed under the regulation.

  7. VA form 10-3567 Staffing Profile • § 51.31 Surveys for recognition and/or certification. • General. Both before and after a home is recognized and certified, VA may survey the home as necessary to determine whether it complies with applicable regulations. VA will provide advance notice before a recognition survey, but advance notice is not required before other surveys. A survey, as necessary, may cover all parts of the home or only certain parts, and may include review, audit, and production of any records that have a bearing on compliance with the requirements of this part (including any reports from state or local entities), as well as the completion and submission to VA of all required forms. The Director will designate the VA officials and/or contractors to survey the home.

  8. VA form 10-3567 Staffing Profile Part I: • Record full name of the SVH and date of inspection at the top. Date should be day the form is filled out. • These top 5 ALWAYS need a number: • Operating beds/participant slots – total beds • Authorized Approvals - # of VA recognized beds • Patient Census – Veterans and Non-Veterans • FTEE Authorized – Total allowed ceiling • FTEE Available – How much of ceiling used • Data is day of survey, not an average.

  9. VA form 10-3567 Staffing Profile Part II: • Total FTEE in “Total Facility” column, then FTEE breakdown for each level of care. • FTEE = ANY FTEE working in the facility. • Do not use words such as contract, or agency. • FTEE only required per 38 CFR Parts 51. • If SVH would like to list other staff disciplines, use “Other” category. However, need to specify who is counted.

  10. VA form 10-3567 Staffing Profile Part III – V: • Second page has instructions for Part III – V to compute the nursing hours per patient day. • Instructions account for different shift hours. • Only direct care nursing hours should be captured in the equation. • Select 4 separate 1 week worked schedules (7 days) at random from previous 12 months, and one week includes one holiday. • If the level of care (ADHC, NHC, DOM) has more than one building, a separate form should be used for each separate building as a pre-work to capture all buildings. The final should be an average of each of the separate buildings.

  11. Eligibility – Nursing Home • § 51.50 Eligible veterans—nursing home care A veteran is an eligible veteran for the purposes of payment of per diem for nursing home care under this part if VA determines that the veteran needs nursing home care; is not barred from receiving care based on his or her service (see 38 U.S.C. 5303, 5303A), is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12) and is within one of the following categories:

  12. Eligibility – Nursing Home (a) Veterans with service-connected disabilities; (b) Veterans who are former prisoners of war, who were awarded the Purple Heart, or who were awarded the medal of honor under 10 U.S.C. 3741, 6241, or 8741 or 14 U.S.C. 491; (c) Veterans who were discharged or released from active military service for a disability incurred or aggravated in the line of duty; (d) Veterans who receive disability compensation under 38 U.S.C. 1151; (e) Veterans whose entitlement to disability compensation is suspended because of the receipt of retired pay; (f) Veterans whose entitlement to disability compensation is suspended pursuant to 38 U.S.C. 1151, but only to the extent that such veterans' continuing eligibility for nursing home care is provided for in the judgment or settlement described in 38 U.S.C. 1151;

  13. Eligibility – Nursing Home (g) Veterans who VA determines are unable to defray the expenses of necessary care as specified under 38 U.S.C. 1722(a); (h) Veterans solely seeking care for a disorder associated with exposure to a toxic substance or radiation, for a disorder associated with service in the Southwest Asia theater of operations during the Persian Gulf War, as provided in 38 U.S.C. 1710(e), or for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998, as provided and limited in 38 U.S.C. 1710(e); (i) Veterans who agree to pay to the United States the applicable co-payment determined under 38 U.S.C. 1710(f) and 1710(g). Note 1 to paragraph (i): Neither enrollment in the VA healthcare system nor eligibility to enroll is required to be an eligible veteran for the purposes of payment of per diem for nursing home care. • After each regulation is going to be a reference to further authority. (Authority: 38 U.S.C. 501, 1720(f), 1741-1743)

  14. Eligibility – Domiciliary • § 51.51 Eligible veterans—domiciliary care (a) A veteran is an eligible veteran for the purposes of payment of per diem for domiciliary care in a State home under this part if VA determines that the veteran is not barred from receiving care based on his or her service (see 38 U.S.C. 5303, 5303A), is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12), and the veteran is:

  15. Eligibility – Domiciliary (1) A veteran whose annual income does not exceed the maximum annual rate of pension payable to a veteran in need of regular aid and attendance; or (2) A veteran who VA determines has no adequate means of support. The phrase “no adequate means of support” refers to an applicant for domiciliary care whose annual income exceeds the rate of pension described in paragraph (a)(1) of this section, but who is able to demonstrate to competent VA medical authority, on the basis of objective evidence, that deficits in health or functional status render the applicant incapable of pursuing substantially gainful employment, as determined by the Chief of Staff of the VA medical center of jurisdiction, and who is otherwise without the means to provide adequately for himself or herself, or be provided for in the community. (b) For purposes of this section, the eligible veteran must be able to perform the following:

  16. Eligibility – Domiciliary (1) Daily ablutions, such as brushing teeth, bathing, combing hair, and body eliminations, without assistance. (2) Dress himself or herself with a minimum of assistance. (3) Proceed to and return from the dining hall without aid. (4) Feed himself or herself. (5) Secure medical attention on an ambulatory basis or by use of a personally propelled wheelchair. (6) Have voluntary control over body eliminations or have control by use of an appropriate prosthesis. (7) Participate in some measure, however slight, in work assignments that support the maintenance and operation of the State home. (8) Make rational and competent decisions as to his or her desire to remain in or leave the State home.

  17. Eligibility – Adult Day Health Care • § 51.52 Eligible veterans—adult day health care A veteran is an eligible veteran for payment of per diem to a State for adult day health care if VA determines that the veteran: (a) Is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12); (b) Is enrolled in the VA health care system; (c) Would otherwise require nursing home care; and

  18. Eligibility – Adult Day Health Care (d) Needs adult day health care because the veteran meets any one of the following conditions: (1) The veteran has three or more Activities of Daily Living (ADL) dependencies. (2) The veteran has significant cognitive impairment. (3) The veteran has two ADL dependencies and two or more of the following conditions: (i) Seventy-five years old or older; (ii) High use of medical services, i.e., three or more hospitalizations per calendar year, or 12 or more visits to an outpatient clinic or to an emergency evaluation unit per calendar year; (iii) Diagnosis of clinical depression; or (iv) Living alone in the community. (4) The veteran does not meet the criteria in paragraph (d)(1), (2), or (3) of this section, but nevertheless a licensed VA medical practitioner determines the veteran needs adult day health care services.

  19. Life Safety – NFPA - Domiciliary • NFPA = National Fire Protection Association • All Code References are from NFPA 101-2012 according to 38 CFR Part 51.350. “The State home domiciliary care programs must comply with the requirements of §51.200, except §51.200(a), (b), (d)(1)(ii) through (x), (f), and (h)(3) concerning the physical environment. §51.200   Physical environment. The facility management must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public. (a) Life safety from fire. The facility must meet the applicable provisions of NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code.

  20. Life Safety – NFPA - Domiciliary §51.200   Physical environment. (b) Emergency power. (1) An emergency electrical power system must be provided to supply power adequate for illumination of all exit signs and lighting for the means of egress, fire alarm and medical gas alarms, emergency communication systems, and generator task illumination. (2) The system must be the appropriate type essential electrical system in accordance with the applicable provisions of NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code. (3) When electrical life support devices are used, an emergency electrical power system must also be provided for devices in accordance with NFPA 99, Health Care Facilities Code. (4) The source of power must be an on-site emergency standby generator of sufficient size to serve the connected load or other approved sources in accordance with NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code. • IF YOU HAVE A GENERATOR, you must maintain it.

  21. Life Safety – NFPA - Domiciliary • Several chapters in NFPA could be considered applicable for a domiciliary setting: Chapter 24 - New & Existing One- and Two-Family Dwellings Chapter 26 - Rooming and Lodging Houses Chapter 28 - New Hotels and Dormitories Chapter 29 - Existing Hotels and Dormitories Chapter 30 - New Apartment Buildings Chapter 31 - Existing Apartment Buildings Chapter 32 - New Residential Board and Care Chapter 33 - Existing Residential Board and Care (Large & Small)

  22. Life Safety – NFPA - Domiciliary Chapter 24 - One- and Two-Family Dwellings • 1 and 2 family dwellings which shall include those buildings containing not more than two dwelling units in which each dwelling unit is occupied by members of a single family with not more than three outsiders, if any, accommodated in rented rooms.

  23. Life Safety – NFPA - Domiciliary Chapter 33 - New Residential Board and Care • 33.2 Small - Shall apply to occupancies providing sleeping accommodations for not more than 16 residents. • 33.3 Large - Where there are sleeping accommodations for more than 16 residents. Personal Care. The care of residents who do not require chronic or convalescent medical or nursing care. Residential Board and Care Occupancy. An occupancy used for lodging and boarding of four or more residents, not related by blood or marriage to the owners or operators, for the purpose of providing personal care services. Residential Board and Care Resident. A person who receives personal care and resides in a residential board and care facility. Staff (Residential Board and Care). Persons who provide personal care services, supervision, or assistance

  24. Life Safety – NFPA - Domiciliary Chapter 33 - New Residential Board and Care • Evacuation Capability. The ability of occupants, residents, and staff as a group either to evacuate a building or to relocate from the point of occupancy to a point of safety. • Impractical Evacuation Capability. The inability of a group to reliably move to a point of safety in a timely manner. • Prompt Evacuation Capability. The ability of a group to move reliably to a point of safety in a timely manner that is equivalent to the capacity of a household in the general population. • Slow Evacuation Capability. The ability of a group to move reliably to a point of safety in a timely manner, but not as rapidly as members of a household in the general population. • Definition in 3.3.76.

  25. Change in Administration §51.210 – Administration (b) Disclosure of State agency and individual responsible for oversight of facility. The State must give written notice to the Office of Geriatrics and Extended Care, VA Headquarters, 810 Vermont Avenue, NW, Washington, DC 20420, at the time of the change, if any of the following change: (1) The State agency and individual responsible for oversight of a State home facility; (2) The State home administrator; (3) The director of nursing services (or other individual in charge of nursing services); and (4) The State employee responsible for oversight of the State home if a contractor operates the State home.

  26. Change in Administration §51.210 Administration (b) • DOM (§51.390) The State home must follow §51.210 regarding administration in providing domiciliary care. • ADHC (§51.475) The State home must comply with all administration requirements set forth in §51.210 except for the following if the adult day health care program does not offer medical supervision.

  27. Change in Administration §51.210 Administration (b) VACO Address: Barbara Hyduke, MHA Acting Executive Director Office of Geriatrics ad Extended Care (10NC4) 810 Vermont Avenue, N.W. Washington, D.C. 20420

  28. Recognition §51.20 (d)(2) Effect of Recognition: After a State home is recognized, any new annex, new branch, or other expansion in the size or capacity of a home or any relocation of the home to a new facility must be separately recognized. Examples: • New Addition to existing SVH • New Location for an existing SVH • Increase in bed numbers for an existing SVH • Change in level or care that increases the recognized bed numbers

  29. Subpart B - Certification • New in AO88** • No recognition survey needed to request a reduction in recognized bed numbers within the same level of care. • What does this mean for States? • Send a letter of Notification of request to decrease beds in same level of care to GEC VACO • Letter should be dated and give explanation • Letter should state the effective date of decrease; not retroactive from date on letter • GEC VACO will respond to notification to the State & VA (Reps, VISN & Per Diem Offices) • Working on SOP for States and VA

  30. Subpart B – Certification §51.30 Certification of a State home • (c) “Decreasing capacity for a program of care. The State must report any decreases in the capacity for a particular program of care to the Office of Geriatrics and Extended Care in VA Central office…….., no later than 30 calendar days after such decrease, and must provide an explanation for the decrease.”

  31. Subpart B - Certification §51.31 (b) Surveys for recognition and certification “VA will not conduct a recognition survey unless the following minimum requirements are met” • (1)–For NH and DOM – need 20 residents or 50% of the resident capacity of the SVH • (2) – For ADHC – need 10 participants or 50% of the participant capacity of the SVH

  32. Work in a Domiciliary §51.300 Resident rights and behavior; State home practices; quality of life (b) Work. The resident must participate, based on his or her ability, in some measure, however slight, in work assignments that support the maintenance and operation of the State home. The State Home management must create a written policy to implement the work requirement. The resident is encouraged to participate in vocational and employment services, which are essential to meeting the psychosocial needs of the resident.

  33. Work in a Domiciliary §51.300 Resident rights and behavior; State home practices; quality of life (b) Work. The resident must perform work for the facility after the State home has accomplished the following: (1) The facility has documented the resident’s need or desire to work in the comprehensive care plan; (2) The comprehensive care plan described in § 51.310 specifies the nature of the work performed and whether the work is unpaid or paid; (3) Compensation for work for which the facility would pay a prevailing wage if done by non-residents is paid at or above prevailing wages for similar work in the area where the facility is located; and (4) The facility consulted with and the resident agrees to the work arrangement described in the comprehensive care plan.

  34. Work in a Domiciliary Summary: • Work requirement however slight is up to the States. • VA does not dictate: • Type of work • Compensation • Regulation states: • Written Policy to implement this requirement • Need has been documented in comprehensive care plan

  35. Contacts • Valarie Delanko, RDN, LDN, CPHQ National Program Manager SVH Quality & Survey Oversight 814-860-2201 • Jo Anne Parker, MHA National Program Manager SVH Survey Process 202-623-8328

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