Final
Division of State and Veterans Nursing Homes

STATE AND VETERANS NURSING HOMES

Votes:
Action Taken:
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10:20 AM -- Division of STate and Veterans Nursing Homes

Ken Cole, Deputy Director and Chief Financial Officer, Office of Behavioral Health and Housing, Colorado Department of Human Services (CDHS), and Dr. John Johnson, Director, Division of State and Veterans Nursing Homes, CDHS, reviewed the document entitled State and Veterans Nursing Homes Facility Staffing and Financial Operations (Attachment D). The presentation included information pertaining to:


10:28 AM

Dr. Johnson distributed a quality resources flow chart for the Division of State and Veterans Nursing Homes (Attachment E). Mr. Cole responded to questions from Representative Jahn concerning the FSVNHAC recommendations and stated that the Division of State and Veterans Nursing Homes will submit a supplemental request in January 2006 to the Joint Budget Committee and the General Assembly for funding for a management company contract for all state and veterans nursing homes. In addition, he stated that for this interim, the Division has chosen to hire consulting firms for the state and veteran nursing homes. He also indicated that the Division of State and Veteran Nursing Homes is in compliance with the recommendations of the FSVNHAC. Representative Jahn expressed her disappointment that the CDHS did not take the FSVNHAC recommendations into direct consideration.


10:36 AM

Dr. Johnson continued his presentation of the quality resources flowchart and stated that there are many employees of state and veterans nursing homes who are continuously reviewed. Representative Tochtrop stated that many of the nursing homes are located in rural areas and asked if the consultants are from those areas. Dr. Johnson stated that many of the consultants are from the same areasin which the nursing homes are located.

Dr. Johnson said that state resources available to the Division of State and Veterans Nursing Homes include: planning; contracts; project management; and purchasing. Dr. Johnson stated that the lag time for the state veterans nursing homes is currently not a problem. He also stated that the hiring process in state government takes longer than the hiring process in the private sector.


10:50 AM

Dr. Johnson referred to Table 2, Attachment D, and noted that the average resident acuity for the Fitzsimons nursing home for FY 2002-03 was 2.8 while the average nursing staff hours was 7.0 and noted that the nursing hours and resident acuity is leveling off. He discussed the monitoring process for nursing staffing needs that include: weekly key factor reports and census (actual to budget); resident acuity; nursing hours per patient day; and details of overtime hours (to address cost control and staffing issues).


10:55 AM

 Dr. Johnson referred to Table 1, Attachment D, that outlines the FY 2005-06 Budgeted FTE. He also distributed a document entitled State Veterans Nursing Home Review: Distribution of VA Survey Outcomes for FY 2005(Attachment F). He stated that the Division has met 94.8 percent of the survey outcomes. Also distributed was a sheet that compares the average hourly salaries for nursing staff at the state and veteran facilities to the average salaries of the Colorado Health Care Association (Attachment G).


11:02 AM

Peggy Valdez Olivas, Human Resources Director, CDHS, stated that the health care benefits for employees of the nursing homes compare unfavorably with private sector benefits and contribute to the difficulty of filling vacancies. In addition, the hiring process utilized by the state is time consuming also contributes. She stated that the average time it takes to fill vacancies at the Fitzsimons State and Veterans Nursing Homes is 32 days. She also stated that hiring nurses does not take as long and may take as little as four days.


11:06 AM

Senator Tupa mentioned that there is a health care professional shortage across the state and asked if Colorado's less generous benefit package hurts recruitment efforts. Ms. Olivas agreed.


11:14 AM

Ms. Olivas reviewed the recommendations of the FCVNHAC. She sated that with regard to recommendation #6, which requests that the State Personnel Board reconsider residency waivers for the nursing home administrator and admissions coordinator positions, the Division has received the approval of two residency waivers from the State Personnel Board. She also noted that concerning Recommendation #7, which requests salary surveys be conducted of professional nurses, the CDHS requested that the Department of Personnel conduct the salary surveys which has been completed. Recommendation #8, which requests the identification of opportunities for enabling the state to loan or share other state or local government employees, has also been explored and Ms. Olivas explained that statutory change would be required to share state employees. Representative Jahn stated that she would pursue such legislation during the 2006 session. Ms. Olivas also stated that the Division has pursued Recommendation #9, which requests the expedited screening of job applicants. CDHS is attempting to make improvements to the hiring process.


11:21 AM

Wayne Valley, United States Department of Veterans Affairs, and Vicky Manley, Department of Health Care Policy and Financing, came to the table to comment on the remaining portions of the presentation (Attachment D). This portion of the presentation included information pertaining to:


11:26 AM

Ms. Manley distributed the document entitled Colorado Medicaid Class 1 Nursing Facility Rate Setting Process (Attachment H) and Colorado Medicaid July 1, 2005 Class 1 Nursing Facility Nursing Rates As of October 19, 2005 (Attachment I). She referred to Attachment I and stated that four of the five nursing home facilities have been audited. Attachment H provides an overview of the per diem rate setting process. There are three components included in the per diem rate: property; administrative and general; and health care.

The committee discussed the per diem rates for the state veterans nursing home per diem rates shown on page 2, Attachment I. Mr. Cole stated that the rates do not include pharmaceutical costs.


11:34 AM

Mr. Valley distributed documents entitled State Veterans Nursing Homes VA Per Diem Overview (Attachment J) and U.S Department of Veterans Affairs State Home Programs FY 2004 Questions and Answers (Attachment K). He noted that the current per diem rate for state veterans nursing homes for FY 2005 is 63.40 which is an increase of $4.04 from FY 2004.


11:48 AM

Representative Tochtrop reminded the committee that they must focus on all the nursing home facilities even though the Fitzsimons facility has been a priority. Senator Entz requested that the Domiciliary at the Homelake State and Veterans Nursing Home be discussed at the next meeting. In addition, Senator Tupa suggested exploring increasing compensation for nursing home employees if Referenda C and D pass.


11:54 AM -- Adjourn

The committee adjourned. Following the meeting, the committee toured the Fitzsimons State Veterans Nursing Home. The next meeting of the committee will be held on December 14, 2005, in Senate Committee Room 356 at the Capitol Building.