pennsylvania DEPARTMENT OF MILITARY AND' VETERANS AFFAIRS July13,2023  SOUTHEASTERN VETERANS' CENTER ADVISORY COUNCIL MEETING MINUTES  The Southeastern Veterans' Center Advisory Council met July 13, 2023 at 10:00 AM in the All- Purpose  Room at the Southeastern Veterans' Center. Advisory Council Members Participating: Barry Amole, Vietnam Veterans of America, President Kenneth Schweitzer, American Legion, Secretary Richard Doherty, Military Officers Association of America Thomas Applebach, Lehigh County Office of Veterans' Affairs Kenneth Nadwodny, Catholic' War Veterans Robert Richardson, Resident Representative John Getz, Veterans of Foreign Wars Thomas Brown, Veterans of Foreign Wars The Hon. Tracy Pennycuick, PA: State Senate Daniel Kuper, Resident Representative Maureen Weigl, BG (PA)-D DMVA Travis Davis, Executive Director, Long-Term Care -DMVA Barbara Raymond, BVHI Director- - DMVA Mike Hoover, Chief of Operations- DMVA Josh Spigner, Regional Compliance Officer- DMVA Erica Moore, Regional Program Outreach Coordinator-DMVA Mike Belcher, Veteran Service Specialist- DMVA Brian Gula, Commandant- - SEVC Lauren Stenson, Director of Nursing-SEVC Jill Alwine, Admissions and Marketing Coordinator-SEVC Sarah Klufas, Assistant to the Commandant- -SEVC  Department of Military and Veterans' Affairs/Southeastern Veterans' Center:  Visitors:  Nikki Whitlock, Constituency Relations, Senator Katie Muth's Office Lisa Walters, Chief of Staff, Senator Tracy Pennycuick's Office Linda Neiman, Veterans of Foreign Wars Auxiliary  Anna Brown Excused Absence: Mary Archey, Marine Corps League, Vice President Jeffrey Elliot, PA AMVETS Doug Forsythe, Disabled American Veterans VACANT, PA House of Representatives MGI Mark. J. Schindler, Adjutant General DMVA Robert Stone, American Legion Advisory Council Meeting. July 13, 2023  Page 1of8    Call to Order:  The Advisory Council Meeting was called to order by Barry Amole at 10:00 AM. There was a moment of  silence, followed by the Pledge of Allegiance. Review and Approval of April 13, 2023 Meeting Minutes:  A motion was made by. John Getz and seconded by Thomas Brown to approve the minutes of the Advisory Council Meeting held on April 13, 2023. Motion carried, and minutes were approved as written.  Report of the Medical Director:  Lauren Stenson, Director of Nursing, reported on behalf of Medical Director Dr. Monika VanSant. We are currently in our window for our Department of Health annual survey, SO we have started doing some preparations. We have onboarded 3 nurses and 3 CNAS since the last Advisory Council meeting. We are currently recruiting for a full-time CRNP and another Assistant Director of Nursing, along with our SEVCi is moving forward on the collaboration with Reading Area Community College to become one oft their clinical sites for their nursing program. We have another meeting with them next week. In addition, our nursingadminstration willl be keeping an eye outi for careert fairsand other events at local colleges to attend We opened our 3 West unit of Coates Hall in May and are trying to fill as many of those beds as we can,  continuous search for RNs, LPNS, and CNAS.  tol let our presence be known within the community. while maintaining a healthy staff ratio for the facility. Report of the Admissions and Marketing Coordinator:  Jill Alwine, Admissions Coordinator, provided the council with an admissions update. Jill reported that as of June 30, 2023, the facility had 201 residents, leaving us with 91 vacancies. The reasonings for the bed vacancies are due to: staffing issues and our 3 East unit being reserved for quarantine. At this point we only have 2 available beds that we can fill, and we have admissions currently scheduled for them. Once we get a better complement of staff, we will be able to fill more beds. We have been working with the local VA medical centers to ensure we can get residents in here that need tol be here. The Coatesville Medical Center recently closed one of their homeless buildings, SO we received many referrals for our personal care unit and were able to admit some of those residents as well. There are currently 77 people on the waitlist, 64 veterans and 13 non-veterans/ spouses. The approximate waitlist times for skilled nursing and personal care are 3-6n months and 2-4 months, respectively. Our memory care unit is currently about a 15-18 month Richard Doherty asked Jill to repeat the waitlist times and wondered about how many admissions we do a year. Jill stated that year-to-date we have taken in about 36 admissions SO far. Our waitlist is down from last year, which was about 120-150 people. Richard Doherty stated that he does not believe that the community knows much about our state veterans' homes and asked that we provide handouts to him to pass along. Thomas Applebach stated that the DMVA has 21 trifolds that provides information on our homes. Jill Alwine stated that if anyone wants pamphlets about our home, that she can provide those after the meeting. She also stated that we do attend expos and work with social workers in the community to try  wait, due to it being our smallest area.  and get the word out and educate everyone the best we can.  Advisory Council Meeting. July 13, 2023  Page 2of8    Report of the Deputy Adjutant General - General Maureen Weigl - DMVA: General Weigl began by welcoming Senator Pennycuick to the council.  Gen Weigl stated that we are sitting at a census of about 1051 across all 61 homes. At the beginning of the Gen Weigl also wanted to offer kudos to her team and Christine, the new Commandant at Hollidaysburg. Construction for the new building at Hollidaysburg has been ongoing. Unfortunately, earlier this week while they were digging, they cut all the powerlines. Two buildings were: affected, and some residents needed to be evacuated to the' VA. Generators were brought in to keep the power going. Greg Lehman and the maintenance team were up all night working with the contactors to fix thei issues. There were also other organizations in the community like Sheetz and Walmart that pitched in to help where they Gen Weigl informed the council that Senator Pennycuick, who was in attendance, started a women's health taskforce initiative and signed into legislation Women's Veteran's Dayt to be celebrated on. June 12th. Two pieces of legislation that are still pending are the increase in the paralyzed and blind pensions, We are continuing to educate veterans in the community about the PACT ACT. We really want to try and get the word out. We will gladly come to your local chapters and: sit down and talk about the benefits and even bring our mobile vans to help people do their claims. When we are in those smaller environments, we can have more intimate conversations and really determine what people need. We are also reaching out to all the homes to make sure that residents and staff know about their claims and benefits. Kenneth Nadwodny: stated that he has been receiving calls from spouses and children of veterans asking about what they can do for their loved one when they are incapacitated. Gen' Weigl stated that we are trying to work on campaigns that put the word out about these programs to al broader demographic, including these caregivers. Thomas Applebach stated that there is a county office of veterans' affairs in every county in PA and his advice to everyone is to direct these people to call their county office for guidance. He also stated that the VAi is mailing letters about the PACT ACT and the additional benefits to all the veterans ini their system, and that they are getting al lot of calls from people inquiring about it.  year, we started at about 950.  could.  going anywhere from 150 to 200 or even 250.  Report of the Executive Director, Long Term Care - Travis Davis - DMVA:  Travis Davis started off by introducing Mike Hoover, Chief Operating Officer for the veterans' homes. Regarding the incident at Hollidaysburg, we had to utilize our Emergency Management plans. Our staff are trained ont these each year and, although wel hope to never have to use them, we did on Monday. The team responded very well, and all the residents were kept safe. We had 245 residents on campus when this happened, about 174 were potentially affected and we had plans in place to transport and place 147 residents at one point. Fortunately, we were able to restore power to some parts of the campus and we only! had to relocate 191 residents to our local VA. Mike Hoover met with the team at Hollidaysburg and they discussed what went well, what we could improve on, and where communication can bei improved in case this happens in the future. We are going to roll this out to all our facilities, SO we are even better prepared to handle something like this int the future. The other 51 homes are equipped with newer, generators where, if we ran into a similar issue here, the generators would be able to handle more than just your basic lifesafety measures. Because we are putting up the new building at Hollidaysburg, their system was not  upgraded at that time. We expect to be back on utilities there by the end of next week.  Advisory Council Meeting. July 13, 2023  Page 3of8    We have had over 20 inspections from outside agencies take place across the 61 homes. Ina addition to that, Travis informed the council that we are going to be posting the Advisory Council minutes on the DMVA website to increase our transparency. They were posted years ago, but throughout Covid and everything, it has fallen by the wayside. After the meetings, a draft version of the minutes willl be posted online. Once the minutes have been approved at the next meeting, they will be moved to an approved final status. The state budget still has not passed. We do not quite know what it means for us and long-term care. We believe what we will likelys seei is a: 1%i increase for Medicaid. This could change, but this is whatouradvocacy groups and membership groups believe will happen. If that does happen, we will have some concerns, especially with the 17.5% increase last year for Medicaid. Our operating costs have significantly increased due to staffing shortages, increases in PPD, and the DOH increasing our minimum staffing requirements. So, depending ony where the state budget goes next year, if we see a moderate to lowi increase in Medicaid, our question is where is that funding coming from to sustain year 2 oft the increase. We typically staff higher than the state minimums, sO we feel comfortable that we will be in compliance with the new ratios. Thomas Applebach asked who sets the ratios. Travis replied that right now they are state governed, SO the Department on Health sets those ratios, but CMS is looking at a minimum for the nation. Nothing has been passed yet. Thomas Applebach asked why they are increasing the ratios. Senator Pennycuick stated that therei is al billi int the House andi the Senate to require staffing minimums. Travis stated that we are in a good position right now with our ratios as we: staff higher due to our population. However, we do not believe in a' 'one-size fits all' approach to staffing. Senator Pennycuick agreed that one-size does not fits all and that Out oft the 6 homes, there are 3 homes that are 5- stari facilities, Delaware Valley, Gino Merli, and Erie. Our Hollidaysburg and Southwestern facilities are currently ranked at 4-stars, and Southeastern is currently a 3-star facility. There is currently no covid among residents or staff. Currently, we have a waitlist of 263 veterans and spouses from across the state. Recruitment and retention remain our biggest challenge. Our total complement fora all 6 veterans' homes isj just under 2200and we currentlyl haves severalhundred vacant positions. We are still hosting events, such as the Walk-in Wednesdays, to help recruit for these vacant positions. In each home about 30% of beds remain vacant and that is mainly due to staffing. The issue is not that we do not have enough staff to care for our veterans, it is that we do not have enough staff to fill Regarding some key positions, we recently named a new Commandant for the Hollidaysburg facility. We also have a new Director of Nursing at the Delaware Valley facility, and we are actively recruiting for Senator Pennycuick stated that if Travis sends her the vacancies that she will post them on her webpage John Getz asked why Southeastern is only rated a 3-star facility. Brian Gula stated that he will talk a little  the DMVA has also completed facility performance appraisals at! 5 of our 6 homes.  However, it could limit our ability toi fill our beds to some degree.  is al huge issue, especially when we have such a nursing shortage.  all the beds.  additional help on the physician's service side here at Southeastern.  and her e-blast.  more about that during his report.  Advisory Council Meeting July 13, 2023  Page 4of8    Report of the Director of Veterans' Homes - Barbara Raymond - DMVA:  Barbara Raymond started by stating that since we last met, the public health emergency has ended. The vaccine mandate will officially be ending as of August 6th. However, the CMS has stated that they will not enforce the vaccine mandates prior to it ending. Right now, we: are not including the vaccine mandate on any of our job postings. We were hoping to a slight uptick int the number of applications we received for our postings once it was removed. We have not seen this yet, but we did just take it off. We are currently monitoring a strain of the Covid Omicron virus called XBB. It has been in the states since thef fall timeframe. Iti is currently not the dominant strain, but it has been ini the news lately. Unfortunately, this strain is pushing past immunities from having covid prior as well as those that are vaccinated. We have gone about 2 weeks since anyone at our homes has been Covid positive and about 3 months since any major outbreaks. Come the fall time, we are expecting to see an increase in cases just like with influenza. We had no influenza deaths this year and only 1 death attributed to Covid, although it We did have new Department of Health regulations come into effect as of. July 1, 2023. One of those regulations as mentioned prior was the increase int the staffing ratios. The other regulatory changes were primarily inl line with CMS. At thel homes we have gone through and undated our policies and procedures Since we last met, we celebrated Nurses' Week, CNA Week, and' Veterans Home week. Brian will touch on In addition to the power outage at the Hollidaysburg facility, the Department of Health came in that day to the facility to conduct their annual survey. They were kind enough to step out and return the next day. Int the end, they decided to exit and not conduct the survey this week. We are guessing they will be back Robert Richardson stated that he has yet to hear of anyone getting al PPD. Barbara Raymond stated that our rules are a little bit different. Upon admission or hire, you receive them. However, unless your county isi in a high TB area, we are only required to check for symptoms. You: should be asked about symptoms on  was not the primary cause.  so that we: are fully compliant with the new state regulations that just took effect.  this more in this report.  sometime in the near future, probably next week.  an annual basis.  Report of the Commandant - Brian Gula- SEVC: Mildred as she is out on a planned leave.  Brian Gula stated that along with his report, he will be giving an update on construction projects for To address the question posed earlier by. John Getz, Southeastern is currently at a 3-star rating. This isa national rating system for all nursing homes and the information is available to the public. The three major categories that this rating is broken into is quality measures, health inspections, and staffing. Our current rating is really driven byt the outcome of our health inspections. Currently, SEVC is ata a! 5-star rating for staffing, 3- star rating for quality measures, and 2-star for health inspections. Scores are refreshed quarterly. The good news is that when scores refresh in. July, we will return to a 4-star rating. The issue is health inspections affect your star rating for 3 years. Every time the facility receives a deficiency, the deficiency is assigned a certain number of points based on the severity. The more points you have, the worse your star rating is for health inspections, the lesser amount of points you have, the better your star ratingi is. Back in June 2020, at the beginning of Covid, our facility unfortunately had a veryt tough survey and received 156 points for this survey. So come the refresh in  Advisory Council Meeting July 13, 2023  Page 5of8    July, after that 3-year mark, those points will be dropped from our rating. In response to a follow-up question asked by. John Getz, Brian further explained that during that survey, the facility received one of Travis Davis stated that of the 3 categories that the star ratings are based upon, most of are facilities are at a 5-star for staffing and we are really trying tot focus ont the quality measure piece. We have a quality team that helps support the quality teams at the homes and we are seeing improvements on those General Weigl reiterated that the surveys are public, and anyone can review the information and see what type of deficiencies a home has received. She stated that deficiencies can be in many different areas such as food not being at the right temperature, calendars for resident events not being updated, etc. Itis not all lifesafety or neglection issues. Furthermore, she told the council that if anyone has any concerns or would like to view the findings of the health inspection surveys, that they can reach out to us, and we can direct them to where the results can bei found or even offer explanations if there are ever any questions. Construction project updates: We will bei installing a security gate on Brown Drive to help prevent unauthorized vehicles from coming onto the property. Security will also be able to monitor the gates via a camera and even open the gates to allow vehicles in. If the gate is closed, staff will be able to open the gate with a swipe of their employee badge. We have plans to have one placed at the top oft thel hill on We are currently replacing all numbered keypads in our CLC building with badge readers as well to enhance security and make sure that residents or unauthorized personnel are not learning the codes and Another big project coming up is the renovation of our staff break rooms. We will be renovating all the staff break rooms in both buildings including newi floors, ceilings, fixtures, furniture, etc. We are currently To reiterate what Lauren Stenson said, we are currentlyi in our window for our annual Department of Health survey. We have audits and processes inj place to prepare for that. We had our VA survey back in February. We were cited for a few minori items. We continue to work on our corrective action plan. There ise education and auditing taking place and we will: shortly present all this back to the VA in hopes iti is We have filled 2 key positions since our last meeting, our Activities Director and our Facility and Grounds Director. We are very excited to have them onboard and are confident that they willl be an asset to our ADHC update: at our last meeting we received our Occupancy Permit, sO we are finally able to utilize the space. We have been using it for staff meetings, trainings, and we used it to host our jobf fair. We are also We had a great month of June celebrating Nurses' week, CNA week, and' Veterans Home week. Nurses' week and CNA week were filled with giveaways, games, gift basket raffles, all provided by staff, pizza, and other yummy treats. For Veterans Home week, our amazing Activities department and Volunteer  the highest severity levels fori infection control and our protocols.  quality measure scores as well.  Dunlap Drive if all goes well.  able to access areas they are not supposed to.  getting staffi input on what they would like to see in their breakrooms.  approved and that we are placed backi in compliance with their regulations.  staff and SEVC.  looking into using it fora a CNA training course.  Advisory Council Meeting July 13, 2023  Page 6of8    department put on a carnival with a pie-eating contest and dunk tank, Luau and pigi roast, big prize Bingo Barb Raymond made sure to reiterate that the state is not permitted to use our state budget to do all the staff appreciation things, SO everything that took place during those weeks was donated by SEVC: staff. Gen Weigl also mentioned we will be hosting a 100th birthday partyi in September for one of our World War II veterans who is in personal care. Nikki Whitlock mentioned that as a resident of SD44, they can John Getz asked if they would have any issues coming in with the new security gates that will be installed. Brian Gula responded that we: are going to see how everything goes, but we will most likely have them open during normal business hours. However, if they are closed for any reason, you will be able to ring a buzzer and someone at the security desk willl be able to let you in. We are installing the first one on Brown Drive to test everything and see how it goes. Barb asked if we will be using pressure pads that will open the gate ont the way out like some of the other homes have. Brian is not sure yet on all the details. Josh Spigner provided a short compliance update. Currently, the exclusion checks that are being run at the homes are being done by staff at each home. We are trying to get on the Justifacts contract sO we can automate this process and run the exclusion checks in a less cumbersome way. Josh also mentioned that the compliance team is doing contractual compliance reviews for Benchmark and Vistamed to make sure  and many more events!  provide a Senate Citation for his 100th birthday.  Compliance Update:  the contracts are being followed. Comments from the Council:  Thomas Brown stated that everyone here is doing a fine job. Furthermore, he wanted to tell everyone to not lose sight of our main goal: helping veterans, including those outi int the community that need our help. Senator Tracy Pennycuick reiterated that they just passed the resolution for the Women Veteran's Health Taskforce, sot they will bel looking over the next 18 monthsa at the women veterans in Pennsylvania and what they are getting for healthcare. She is hoping that taskforce will come up with recommendations to the federal VA to supply more money for the choice program. Additionally, there are some legislative actions, one is to remove the wartime service from the real estate tax exemption. That has been ongoing in several different ways, and we are trying to make that happen. There is also have a bill coming out that would lower the assessment on your real estate for tax purposes. Senator Pennycuick suggested adding John Getz commented that the VFW has a retreat every year and this past year they had 165 women veterans attend. They are hoping to have another retreat in March. Overall, these retreats are very productive and many of thei female veterans are learning a lot about healthcare benefits that they can take Richard Doherty reiterated that everyone needs to push to get the word out to communities, but overall, he thinks everyone is doing an amazing. job. He asked for clarification on the 100th birthday celebration. Richard also asked how old the veterans homes system is. Jill Alwine stated that this building opened in  This should not only be a goal in our working lives, but in our personal lives as well.  informational briefs in the tax bills to help get information out there.  advantage of. He concluded by stating that everyday is' Veterans Day.  Advisory Council Meeting July 13, 2023  Page 7of8    Oct1323,01:26p  p.1  1986 but was not fully operational until about 1991-1992. Gen Weigl stated that Delaware Valley just celebrated their 20th anniversary and Southwestern will be celebrating their 25th anniversary soon. Anna Brown comment that she used to come here to play Bingo back in the 1970s, it was a VA hospital at the Robert Richardson stated that he has been noticing that there is nothing in the state for the Native Americans. He was wondering # we planned on doing anything or looking into that. Gen Weig! answered that there are some programs offered by the Federal VA that we push out, but the: state has not done their own Native American function. She said she will look into doing something for Pennsylvania. Nikki Whitiock stated that they are in the middle of planning Senator Muth's Annual Veteran's Expo. They are shooting for the fall and will let everyone know when there is a date nailed down. Erica Moore introduced herself and stated that in the fall, they will be making visits to the local VFWS and American Legions to provide info to the community about various programs.  time.  Old Business: Nothing to Report. Nesr Business: Nothing to! Report. FectignofOficers  President - unanimous nominations: and election of Barry Amole to serve as President. Vice President - unanimous nominations and election of Mary Archey to serve as Vice President. Secretary unanimous nominations and election of Ken Schweitzer to serve as Secretary.  Good of the Council: Nothing to Report.  Time and Date for the next Meeting:  With no further business to discuss, a motion was made to end the meeting. Motion carried. The next regular meeting of the. Advisory Council will be held on October: 12, 2023 at 10:00a.m.  Approved:  Lenak Seleife Kenneth Schweitzer, Secretary Minutes submitted by: Sarah Klufas  Advisory Council Meeting July 13, 2023  Page Sofs