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Corrected (page 5)
May 3, 2007
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ARIZONA STATE LEGISLATURE
Forty-seventh Legislature – First Regular Session
JOINT SELECT COMMITTEE TO INVESTIGATE OPERATIONS
AND CONDITIONS AT THE ARIZONA VETERANS HOME
Minutes of Meeting
House Hearing Room 1 -- 2:00 PM
Chairman Nelson called the meeting to order at 2:16 p.m. and attendance was noted by the secretary.
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Senator Jack Harper, Chair |
Representative John Nelson, Chair |
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Senator Jim Waring, CoChair |
Representative Bob Stump, CoChair |
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Senator Linda Gray |
Representative Manuel Alvarez |
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Senator Charlene Pesquiera |
Representative John McComish |
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Senator Victor Soltero |
Representative Ben Miranda |
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Representative Jonathan Paton |
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Senator Chuck Gray |
Representative Albert Tom |
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Senator Richard Miranda |
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Chairman Nelson introduced the agenda items.
Presentation by Joint Legislative Budget Committee staff on Funding of Arizona Veterans Home
Amy Upston, Joint Legislative Budget Committee, described the background of General Fund appropriations for the Arizona Veterans Home (Attachment 1). She stated that the Home opened in 1995 and was intended to be self-supporting, but the Legislature did have to appropriate funds to augment the other revenues of the Home. She stated that it has been self-sufficient from 2000 to the present, through the State Home for Veterans Trust Fund.
Ms. Upston explained the turnover and salary statistics for the Home and a salary comparison between the Home and the Arizona Health Care Association noted in Attachment 1.
Senator Harper asked if there were any salary statistics from past years which would reveal a relationship to the reduction in the turnover rate; Ms. Upston replied that she did not have the information at this time.
Senator Soltero asked what caused the difference in the turnover rates of LPNs and RNs; Ms. Upston replied that there are only six RNs so perhaps the percentages are inflated by the small number.
Mr. McComish asked how the Home turnover compares with the industry, and if there is a relationship between turnovers and salary levels; Ms. Upston explained that the turnover rates calculation is not standardized but she has heard that in private industry the turnover rate can be as high as 70 percent.
Mr. McComish asked if the ratio of RNs to LPNs is proper, as the number of RNs seems low to him; Ms. Upston replied that she is not certain what the proper relationship should be.
Chairman Nelson asked what portion of the budget goes to the 225 staff salaries; Ms. Upston replied that staff salaries comprise $12.5 million of the $15 million total operating budget, or over 80 percent.
Update on Corrective Action Plan at Arizona Veterans Home
Rich Steven, Interim Administrator, Arizona Veterans Home, addressed the committee, explaining that he had been hired out of retirement 26 days ago and that his background is in hospital and long-term care administration. He stated that his initial observations are that the Home is a good facility.
Chairman Nelson asked if that was an observation of the physical facility or the services of the Home; Mr. Steven replied that he was referring to the surveys and the information they provided when he stated that this is a good facility which has not had problems on a continuous basis.
Chairman Nelson asked if the complaints were tied mostly to medical patient issues rather than to administrative issues; Mr. Steven replied that year-to-year, according to Department of Health Services (DHS) testimony, the Arizona Veterans Home did not have a significant number of patient-care problems until this year.
Senator Harper asked how the footage from on-site security cameras is handled; Mr. Steven explained that the files are overwritten after 30 days. Senator Harper asked if there were any copies prepared from video footage at the time of the complaints; Mr. Steven stated that he was not aware of any copies made during his short time with the Home.
Mr. Steven continued to explain that much has been addressed at the Home, including attention to call lights and safe smoking protocols. He stated the importance of building a quality staff that is well-trained, well-motivated, and well-compensated. He stated that funds for long-term capital improvements are not there and that preventive maintenance plans must be created.
He encouraged the members to
contact him with any issues or constituent complaints:
602-316-3045.
Mr. Miranda asked Mr. Steven to explain his statement that the facility cannot operate in isolation; Mr. Steven replied that a consensus of all stakeholders is required, that the Home has many volunteers who work there, that the Legislature can provide funding to attract and retain staff, and that the Home must have dollars for capital improvements. He stated that he has not delved into the financial payment system, but if the Home runs approximately 60 percent Arizona Long Term Care System (ALTCS) services and it loses $13 to $16 per day for every ALTCS resident, that’s a pretty big financial hit.
Mr. Miranda asked how many veterans in Arizona qualify to be housed at the Home and if there is a waiting list; Mr. Steven stated that there is a wait list and the Home is at full capacity (193 average daily census) although the current bed freeze has temporarily affected that. He then explained that the Home is now seeing Vietnam veterans in the 60s, rather than the older veterans in their 80s. He stated that veterans from Iraq and Afghanistan are returning home with much different injuries and will require care earlier in their lives and continuing for 40 to 60 years – these soldiers are still in the active military, so have not been seen in the Veterans Administration (VA) system yet. He stressed the importance of anticipating the future needs of this group of veterans.
Mr. Miranda asked what he expects regarding the Iraqi veterans with different disabilities and the impending arrival of the Vietnam vets; Mr. Steven remarked that several million veterans went through Vietnam and their arrival in the system will go on for ten years or more. He stated that Arizona’s population is growing, so new residents in retirement will be using the state’s system. He recommended a campus approach rather than an assisted-living or skilled nursing facility.
Senator Soltero inquired about the waiting list; Mr. Steven replied that there is a list, however the 200-bed facility has only 50 Medicare beds so there is a “mix“ issue where beds may be available, but not in the correct area for the wait-listed veteran.
Senator Soltero asked what he recommends to address the increase in demand for entry to the Home; Mr. Steven replied that long-term care requirements have changed and that the Home must expand the variety and types of services, such as an assisted-living structure and a traumatic brain injury unit with rehabilitative facilities.
Chairman Nelson asked if veterans are Medicare and Medicaid covered; Mr. Steven replied in the affirmative, explaining that some are covered by ALTCS (Medicaid), some by Medicare, and some by third party/private pay.
Chairman Nelson asked about acute care for veterans; Mr. Steven stated that he would research that for the members.
Chairman Nelson asked about an operating plan with procedures to follow and a training plan which will ensure that these problems don’t continue or recur; Mr. Steven stated that the Home will soon have a sophisticated staff training area which will even offer tuition reimbursement in return for an agreement to stay on-staff for a specified period of time.
Chairman Nelson asked if there were any lawsuits currently filed; Mr. Steven replied that he knows of only one. Chairman Nelson asked if such liability discourages working at the Home; Mr. Steven stated that he had not heard anything but would research the topic.
Mr. Miranda made requests for:
· the information on the waiting list, and also
· how many veterans could qualify for the Home but choose other facilities or remain at home.
Mr. Steven commented that many veterans want to be with other veterans, and since nursing homes are mostly populated with female patients, homes for veterans are very important.
Chairman Nelson stated his concern about service levels in Arizona; Mr. Steven stated that DHS is a partner to the Home and is a valuable resource which provides training programs.
Questions to Governor’s Investigatory Team and to the Law Firm who Represented or Is Representing the Arizona Veterans Home
Karen Owens, Coppersmith, Gordon, Schermer and Brockelman, addressed the committee to describe her law firm, comprised of eleven lawyers, which has been given the highest ethical rating and has a health-care focus on regulatory issues threatening a facility’s very existence. She stated that Coppersmith et al are compliance lawyers - not litigation lawyers - whose goal is to return a facility to substantial regulatory compliance. She explained that they also attempt to minimize money penalties and to resolve issues. She stated that Coppersmith et al entered into a contract with the State Attorney General effective January 1, 2007, and was already under contract when the VA work was assigned on March 23, 2007, at 5:00 p.m.
Ms. Owens explained that their work with the VA would address three areas of licensure actions:
Ms. Owens detailed the actions of her firm to address the problem area:
Chairman Nelson asked about the communication gap between February 5 and the end of March; Ms. Owens replied that the administrative and staff changes, including the loss of the Quality Manager at a critical time and the position left vacant for nine months, caused the communication problems. Chairman Nelson asked if there was a request for help and funding back to the Governor’s office to fill these vacancies; Ms. Owens replied that there was not.
Senator Harper asked if her firm was representing the Home in any civil or criminal actions; Ms. Owens replied that her firm does not do litigation, rather it is assisting in establishing the system to handle complaints so that regulatory compliance is reached. She stated that specific complaints are handled legally by the Attorney General’s office, which represents the Home.
Senator Harper asked about attorney-client privilege, since the firm is not representing the Home; Ms. Owens replied that privilege does still apply in civil matters, such as the surveys.
Senator Harper asked if her firm had disputed any accounts in the 94-page DHS survey; Ms. Owens replied that she had prepared an informal dispute resolution statement on March 26, 2007, as she mentioned earlier in her testimony, and copied Medicare, which has a similar process.
Senator Harper asked if she had seen video footage from the Home; Ms. Owens replied in the negative.
Mr. McComish asked if the firm had done any work for the Home prior to March 23; Ms. Owens replied that she was unaware of any work done. Mr. McComish asked for a description of her current duties regarding the Home; Ms. Owens replied that their duties include the following:
Mr. McComish asked who gives her firm the marching orders; Ms. Owens replied that the Attorney General’s office delegated to General Maxon to supervise their activities.
Mr. McComish asked about the many tasks that she listed; Ms. Owens explained that all the tasks are compliance-related and that her firm will work with the clinical leadership in the Home.
Mr. McComish asked her about the dual tasks of representation and investigation; Ms. Owens explained that the investigation portion is required in order to get background and provide assistance to resolve the problems.
Mr. Miranda asked if this situation was triggered by complaints or by a scheduled review; Ms. Owens replied that they were triggered by a scheduled annual survey. Mr. Miranda asked for clarification that her firm is more of a consultant to ensure compliance; Ms. Owens replied that a large part of what the firm does is to ensure that the clinical corrections meet the standards and are written in a way that the regulators will accept.
Mr. Miranda asked if her firm would make recommendations on quality and staff to Mr. Steven, the new Home administrator; Ms. Owens replied in the affirmative.
Discussion and Requests for Additional Information
Chairman Nelson stated that this is a team effort to compile all information and that the committee cannot make a determination yet as it is awaiting Dr. Kirschner’s report.
Mr. McComish and Chairman Nelson requested organization charts for the Arizona Veterans Home and for the Governor’s Cabinet.
Without objection, the meeting adjourned at 4:18 p.m.
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Jane Dooley, Committee Secretary
April 25, 2007
(Original minutes, attachments and audio on file in the Office of the Chief Clerk; video archives available at http://www.azleg.gov/)
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JOINT SELECT COMMITTEE TO
INVESTIGATE OPERATIONS
AND CONDITIONS AT THE ARIZONA VETERANS HOME
6
April 24, 2007
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