State and Veterans Nursing Homes (12/14/2005)

Final
STAFF SUMMARY OF MEETING

STATE AND VETERANS NURSING HOMES

Date:	12/14/2005	ATTENDANCE

Time:	09:30 AM to 11:47 AM	Balmer	X
		Entz	X
Place:	SCR 356	Hodge	X
		Jahn	X
This Meeting was called to order by		Sullivan	X
	Senator Tochtrop	Taylor	X
		Tupa
This Report was prepared by		(None), (None)
	Geoff Johnson	Tochtrop	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:

9:30 a.m.

Senator Tochtrop, Chair, called the meeting to order. All members of the Committee were present with the exception of Senator Tupa.

9:31 a.m. - Preliminary Report from the State and Veterans Nursing Home Commission

Ralph Bozella, Chairman, Commission on State and Veterans Nursing Homes, presented the preliminary report of the commission. The final report of the commission will be delivered to the Legislative Oversight Committee next June. Mr. Bozella said that the commission met four times in the Fall of 2005, visited all of the state and veterans nursing homes and heard testimony from representatives of several state departments.

Mr. Bozella said that the commission now believes that the Department of Human Services (DHS) should manage the state and veterans nursing homes and that an oversight commission should be established to oversee the work of the Department in managing the homes. The commission also recommends that a consulting contract be issued to provide further expertise to the department in managing the homes. Several documents were distributed to members of the Legislative Oversight Committee by Mr. Bozella. A resolution from the Colorado Board of Veterans Affairs, a "Bridge Statement," a copy of the report of the commission and a document addressing the McCandless State Nursing Home, were distributed to committee members (Attachments A through D.) He said that the commission has formed subcommittees to consider issues to be addressed in the future, prioritization of these issues, potential recommendations, and any preliminary legislative proposals.

9:37 a.m.

Senator Entz expressed concern about the use of consulting contracts.

9:42 a.m.

Representative Jahn said that the DHS needs this kind of consulting expertise if it is going to continue to run nursing homes. She said that many problems arose due to this lack of expertise.

Mr. Ken Cole, DHS, commented on how the proposed consulting firm would work with the department.

Mr. Bozella announced that a new commission member, Paula Walker, has replaced Dr. Rudy Arguello, who resigned for health reasons.

9:51 a.m.

Marvin Meyers, Issues Subcommittee, Commission on State and Veterans Nursing Homes, commented on the establishment of an oversight board for the nursing homes. He also commented on issues and concerns facing the nursing homes, including: quality of care in the homes; governance and organizational structure to oversee operation of the homes; clinical benchmarks; and general operations of the homes; low census numbers in some of the homes; and funding of the nursing homes. He said that they have established a productive and effective working relationship with the DHS.

10:04 a.m.

Bill Sinclair, Member, Commission on State and Veterans Nursing Homes, responded to questions posed by Senator Entz. He said that the commission has looked carefully at the issue of management versus consulting. He said that the department had major problems in oversight of the homes in the past and that there should be a transition from full management of nursing homes by contract to a consulting relationship. He noted that additional structure would be imposed on the homes under the commission's recommendations. A new commission to oversee the operations of the veterans nursing homes may eventually be recommended. The existing commission members will consider this possibility in the coming months. Mr. Bozella pointed out that the Commission is to evaluate the current administration of the homes, not to oversee their daily operations.

10:09 a.m.

Mr. Meyers said that the commission is now increasingly comfortable with recommending that the management role once again centered in the DHS. He said that the Lieutenant Governor is comfortable with the idea of having a consulting relationship for the homes.

10: 11 a.m.

Mr. Cole commented on existing consulting contracts maintained by the nursing homes.

10:13 a.m.

Jayla Sanchez Warren, commission member, commented on the activities of a subcommittee of the commission that she chaired, which looked specifically at the operations of the individual nursing homes. She said that the most important information that the subcommittee received was garnered from facility visits.

She enumerated recommendations from the subcommittee. She noted the importance of improving wage and benefit practices for employees of the facilities. She expressed concerns about minimal occupancy rates at the facilities, and suggested investigation of alternative funding sources and quality assurance programs at the facilities. She suggested improvement of the application and hiring processes for the facilities. She said that certain capital improvements at some of the facilities are critical to make them more competitive with the private sector homes. She noted that in some instances employees who are monitoring state prisoners are better compensated than employees staffing the state veterans nursing homes. She commented on the possibility of establishing census monitoring for the facilities.

10:23 a.m.

Mr. Sinclair commented on preliminary legislative proposals. He said that the state personnel system is making it difficulty to operate the nursing homes by hindering the filling of vacant positions. He said that the personnel system is too cumbersome and that the Commission is recommending that an exemption from state personnel rules similar to that provided to the University of Colorado be established for the state and veterans nursing homes.

Mr. Bozella said that operation of the Fitzsimons facility has improved dramatically in a recent surveys.

10:29 a.m. - State and Veterans Nursing Homes - Nursing Salary and Benefit Packages Relative to the Private Sector

Mr. Cole, Department of Human Services, commented on nursing home salary and benefit packages in the state and veterans nursing homes. He said that at some of the state and veterans nursing facilities average employee salaries are higher than they are in the private sector. He suggested that this may be the case due to the length of service and seniority of employees at some of the state and veterans nursing homes. He said that the salary issue is more important at the Fitzsimons facility than at other state and veterans nursing homes. He said that nursing compensation packages are an issue at all state facilities that employ nurses. He commented on health insurance and other benefits at the veterans nursing homes in relation to the private sector.

10:37 a.m. - Potential for Improvement of Salary and Benefit Packages/Survey Results for Nurses at the State and Veterans Nursing Homes

Jeff Wells, Executive Director, Department of Personnel and Administration (DPA), introduced Jeff Schutt, Director, Division of Human Resource Services, DPA, and Karen Fassler, Manager, Total Compensation System, DPA. He said that the department has recently conducted a "system maintenance study" for the nursing profession. He commented on salary and benefit deficiencies in the state personnel system generally.

Mr. Wells said that the issues being raised by the committee are what motivated the reforms to the state personnel system which were proposed a few years ago. He said that it is not possible to create a separate benefit package for the nurses in the state and veterans nursing homes under the state personnel system.

Mr. Wells commented on the salary survey which is conducted each year for state employees and on the "system maintenance study" which was conducted by the department. He noted that Representative Jahn may pursue legislation which would permit the award of salary and benefit increases to employees earlier than the time frames available under current law.

Mr. Wells pointed out that changing salary ranges for nurses does not guarantee immediate raises for all nurses in the system. He said that it may be possible to move the salary survey increases forward. He commented on other options that may be used to make nursing positions more attractive, including initial signing bonuses and retention bonuses. He noted that it may be possible to allow pay increases to be given to nurses so that they are able to catch up to the new employees who are hired at higher salaries. Several of these options would not require legislative changes and could be used if sufficient funding is provided. He suggested that these techniques would be the simplest approach to addressing the matter of making the nursing positions more attractive in the market. He commented on efforts to handle rising health insurance costs.

11:00 a.m.

Mr. Wells commented on the potential for "job sharing" among state agencies. He said that in a crisis an MOU could be implemented to allow nurses to be borrowed from other facilities, for example from correctional facilities.

11:08 a.m.

Representative Jahn discussed her proposed legislation relating to job sharing and implementation of system maintenance studies.

11:09 a.m. - Programmatic and Facility Overview of the Homelake Domiciliary Unit

Dr. John Johnson Director, Division of State and Veterans Nursing Homes, DHS, introduced Kevin Ross Project Manager, Division of Facilities Management, DHS, Mindy Montague Administrator, Colorado Veteran's Center at Homelake, and Brenda Schnaterbeck Acting Director of Nurses, Colorado Veteran's Center at Homelake.

11:12 a.m.

Mindy Montague commented on the special setting of the Homelake facility and its history. She said that Homelake is one of the few nursing facilities in the country designed in a "cottage format." Homelake has 23 habitable cottages and is the only domiciliary unit in the state. Homelake offers numerous services, including house-keeping services, specialty clinics, banking, and on-site physicians. She noted that the facility has been designated a historical site. Challenges to Homelake include the increasing costs of medical care, medications, and transportation. The facility has many capital improvements needs. She said that the cottages are not all handicapped accessible. She noted that the residents have an "independent quality of life." She said that there is a waiting list for entry into the domiciliary unit, and that the facility has an average occupancy of 98%. Homelake has a capacity for 46 residents. She commented on the Homelake Community Advisory Board.

11:20 a.m.

Ms. Schnaterbeck commented on the "day-to-day" operations at the facility. Dr. John Johnson commented on the site visits that commission members made to the facilities and on funding challenges at Homelake.

11:27 a.m.

Mr. Ross, Project Manger, Division of State and Veterans Nursing Homes, commented on funding sources that might be available to Homelake for capital improvements. He said that he is seeking a master plan for the entire facility and looking at facility needs for the next 15 to 20 years. He said that Homelake has submitted an application to the State Historical Fund and to the Veterans Administration to cover a portion of these costs. He noted that Veterans Administration grant funding will not be available for the domiciliary renovation. He said that design funds have been requested from the Capital Development Committee. Next year construction funds will be requested. He commented on a utilities upgrade project that could be paid for with energy savings. He discussed three program buildings that require structural stabilization. He noted that the Veterans Administration has cited the facility for some deficiencies related to unsafe buildings.

11:35 a.m.

Senator Entz commented on past efforts to upgrade facilities at Homelake. He said that it is wrong to have the residents subsidizing the cemetery at Homelake. Rep. Sullivan commented on the possibility of using Great Outdoors Colorado (GOCO) funds to improve recreational opportunities at Homelake.

11:47 a.m.

The committee adjourned.