1. STATE VETERANS HOME Program Updates Nancy Quest Office of Geriatrics and Extended Care Patient Care Services Department of Veterans Affairs

2. 2 STATE VETERANS HOME Resident Assessment Instrument/ Minimum Data Set (RAI/MDS)  124 of 132 transmitting to VA  RAI/MDS 2.0 3.0 requirements –CMS certified facilities will be required to use MDS 3.0 effective October 1, 2010 –Non-CMS certified facilities may continue using MDS 2.0 until VA regulations are revised –VA will have capability to receive 2.0 and 3.0 transmissions Reference – 38 CFR Part §51.110 Resident Assessment

3. 3 STATE VETERANS HOME Recognition and Certification  Once a facility has achieved recognition, the recognition will remain in effect unless the State requests that the recognition be withdrawn or the Under Secretary for Health makes a final decision that the facility or facility management does not meet the standards of subpart D. Recognition of a facility will apply only to the facility as it exists at the time of recognition; any annex, branch, enlargement, expansion, or relocation must be separately recognized. Reference - 38 CFR §51.20(a)

4. 4 STATE VETERANS HOME Bed Change Request Process  Request to withdraw recognition and certification of current facility must come from the State Official authorized to establish the State home Reference - 38 CFR §51.20(a)  Request recognition and certification of the new reduced bed facility Reference - 38 CFR §51.30(2)(b)

5. 5 STATE VETERANS HOME  State should request the withdrawal of the original recognition and certification contingent on and concurrent with recognition of the reduced bed facility  Allow VA to survey the reduced-bed facility Reference - 38 CFR §51.20(b)  Requests for change in the number of recognized beds should be addressed to the Under Secretary for Health

6. 6 STATE VETERANS HOME Status of Federal Regulations / Handbooks  Nursing Home, Adult Day Health Care & Domiciliary regulations – in concurrence –Various sections are identical for all programs Subpart A – General (Purpose & Definitions) Subpart B – Obtaining Per Diem (Recognition Process) Some standards in Subpart D – Standards –Resident Rights –Admin, Discharge, Transfer –Resident Behavior and Facility Practices –Quality of Life –Administration –Standards applicable to each level of care will be identified in separate subsections

7. 7 STATE VETERANS HOME  Significant changes include: –Nursing Home – use of MDS 3.0 –Domiciliary – Primary care provided by physician extender (supervised by physician) –Adult Day Health – flexibility to establish as a social or medical model, stand alone facilities, no requirement to complete home based MDS Changes will become effective 30 days after publication of regulation; regulations are in concurrence and can take up to 2 years to publish

8. 8 STATE VETERANS HOME  Emergency Evacuation Regulation – Per Diem Payments for Veterans Evacuated During an Emergency from a State Home to a Non-Recognized Facility –Per diem is the VA established daily rate paid to a State for providing specified levels of care to eligible veterans once a facility is officially recognized by VA and maintains certification. Changes will become effective 30 days after publication of regulation; regulations are in concurrence and can take up to 2 years to publish

9. 9 STATE VETERANS HOME  This regulation would authorize VA to continue to pay per diem payments when veterans for whom VA is paying per diem are evacuated during an emergency from a State home to a facility that is not recognized by VA as a State home.  The regulation would require, in order for per diem payments to continue while the veteran is relocated due to an emergency, that the director of the VA medical center of jurisdiction recognize the emergency and approve the State home’s response.

10. 10 STATE VETERANS HOME  Assistance for Hiring and Retention of Nurses at State Veterans Homes –The Secretary shall make payments to States under this section for the purpose of assisting State homes in the hiring and retention of nurses and the reduction of nursing shortages at State homes  Grant Program that is designed to –promote the hiring and retention of nursing staff –reduce nursing shortages Reference - 38 CFR Part 53

11. 11 STATE VETERANS HOME  Applications for FY2011 accepted through September 30, 2010 –Additional information can be obtained by contacting Theresa Hayes: Theresa.Hayes@va.g ovTheresa.Hayes@va.g ov 202-461-6771 Reference 38 CFR Part 53

12. 12 STATE VETERANS HOME Reportable Events Handbook  Includes all reporting requirements currently in the Federal Regulations and supplant all other previous guidance  Minimizes the burden on State Homes and VA  Limits reporting to those items of greater significance

13. 13 STATE VETERANS HOME  Major Elements –A distinction between “Required” and “Requested” reports –No requirement for RCA –State home may report using their own format (with some guidelines) –Reporting time frames are provided –Not all adverse events need reporting –Onus on local VA facility to create I.B. as needed

14. 14 STATE VETERANS HOME  Required Reporting –Those reports that are cited in the Federal Regulation Sentinel Events Change in administration  Requested Reports –Change in nursing administration –Substantiated allegations –Elopements pursuant to state regulations

15. 15 STATE VETERANS HOME –Adverse events –Inspections/surveys by oversight agencies –Information regarding the SVH that appears in local or national media  VAMC of Jurisdiction are responsible to communicate the reporting guidelines and relevant contact information to the SVH in their area

16. 16 STATE VETERANS HOME  SVH Regional Training Conferences –Eastern Region (VISN1-8) – Tampa July 20-22 –Central Region (VISN 9-16&23) – Chicago August 10-12 –Western Region (VISN 17-22) – San Antonio August 24-26  MDS 3.0 conferences (cancelled)

17. 17 STATE VETERANS HOME THANK YOU!!