BENNINGTON -- Secretary of the Agency of Administration Jeb Spaulding came to the Vermont Veterans Home's Board of Trustees meeting Wednesday and explained what the state would and would not do in response to a recent report on the home by a consultant.
The home's Board of Trustees also went over a letter to the governor, responding to recommendations in the report.
Spaulding pointed to some positive developments. "You here have been under a lot of pressure from the federal regulatory agency and have met the challenges to allow us to continue getting federal funding. We've seen the census rise really significantly," he said. "I think the plans in place are going to insure a long and bright future for the veterans home, the veterans and families that are served by the good work of the staff and the board put together."
Administrator Melissa Jackson reported that the average daily census at the home has increased by 12 veterans/members per day from June (126) to September (138). This is due to the increased number of patients coming to the home for short-term rehabilitation. On the downside, a year-to-date income and expense statement as of Aug. 31 provided at the meeting shows total actual operating revenue at $2,870,658 and total actual expenses at $3,712,374, resulting in a net income loss of $841,716
Spaulding said he is sort of the chief operating officer of Gov. Peter Shumlin. "And one of his top priorities is to insure a long and stable, quality future for the Vermont Veterans Home."
He addressed recommendations made in an independent review of management and operations of the home which was delivered in August by Health Care Management Associates Inc. The Vermont Agency of Administration solicited the report.
"The legislature asked for that independent review because of the fact that the finances of the Veterans Home were such that the state was having to step in and fill some deficits that we were not used to doing," Spaulding said. "With the ongoing problems we're having with the federal government, and the other challenges we have, we don't have the ability to be a financial backstop to the veterans home in the long run, there's just no way around it."
Veterans homes in most other states run in the black "and we expect Vermont Veterans Home to run in the black," he said. "So I hope I can move on to say that's the direction we want to go. And I think that's why the legislature wanted the independent review."
On personnel issues, he added, "They were also aware of some friction and some potential management/staff issues that had come to their attention. They wanted to make sure they knew what was going on, and there were recommendations that were made."
While the administration doesn't necessarily buy into all of the recommendations in the report, prepared by Michael Pulling, who in the past has served as interim administrator of the Vermont Veterans Home, "we do recognize the underlying gist of what he was saying," Spaulding said.
Spaulding said the home has a good financial future ahead if it makes the right moves. "The demographics are there and the market area is there, and we should be able to attract a healthy number of veterans and family members for the foreseeable future. So that's very good news," he said.
He noted that the report recommended making Deputy Administrator Allan Faxon the CEO, replacing Jackson. "That's not something the governor supports," Spaulding said. "We support our current chief executive officer."
"We are not considering outsourcing senior management," he added.
In addition, current law provides that the licensed administrator -- which Jackson is -- is "the commandant, i.e.. the CEO and we think it ought to stay that way," he said. "We do think that there can be a value to reconfiguring the deputy position to let's say chief operating officer ... We thought that did make some sense."
It would be up to the board of trustees to reconfigure the deputy's position.
"And we will be taking up a handful of those in the legislature. The most significant of which are the senior management positions should be exempt employees not classified employees," Spaulding said. "And it's our belief that if you're going to hold the CEO accountable, (then) the finance director of an operation needs to be an exempt employee operating under the control of the chief executive officer. Other high-level positions like that, for accountability purposes, need to be exempt. We are going to be recommending that change to the legislature."
An audit of the home in 2005 pointed out a legal ambiguity: The veterans home is run by the board of trustees, but a law passed in the 1970s basically said control is by the state Agency of Human Services. The administration agrees that this should be cleared up by the legislature, according to Spaulding.
Some staff members of the Vermont State Employees' Association have asked that one of their ranks be elected to the veterans home Board of Trustees. "We actually feel there may be merit to that idea, for enhanced communications," Spaulding said. "It seems common sense, you would want somebody who's an active practitioner involved in the day-to-day activity involved on the board, not controlling the board but to be a member of the board."
He added, "We leave that to your opinion but we're open to that."
State officials will discuss with the state employees union if specific items could be included in the contract that "apply to the kind of 365-day, 24-hour a day, 7-day a week highly regulated health care facilities that are different" than they would be for workers in, for instance, the Department of Agriculture or the Department of Education.
However, the state does not support creation of a separate union bargaining unit for the veterans home. "The administration feels strongly that this is a time for everybody to pull together. Polarization is not helpful," Spaulding said.
After Spaulding spoke, Board of Trustees President Joseph Krawczyk went over the draft of a letter responding to the Health Care Management Associates to Gov. Shumlin. It contained many similarities to the views Spaulding expressed.
In the letter, the trustees say they will adopt a business model that has a CEO who must be a licensed nursing home administrator (Jackson) and a chief operating officer (Faxon). The reorganized structure of the home would divide personnel into two major functions: Nursing and Clinical Services on one side and and Operations on the other. The current director of nursing services will be responsible for nursing and clinical services and the chief operating officer will be responsible for operations.
"The organizational chart also reflects the proposal that all positions from CEO through clinical care coordinator be managerial exempt," stated the letter, specifically the reconfiguration of eight positions to "exempt status."
The letter notes that the home has 218 employees, all full-time. The board proposes "a staffing model better suited to 24-7 care requirements," one allowing employment of "part-time, temporary or per diem staff." Benefits would not be required for those working 16 or fewer hours per week. "Overall, this proposal should minimize the requirements for both overtime and mandating and have a very positive effect on staff morale," the letter states.
As to finances, the letter states that "the financial director is not well-versed in state fiscal procedures, and several corrective measures are proposed to ensure the fiscal stability of the VVH. These include training for the director and staff both on site and at established veterans homes familiar with state and federal policies and procedures."
On the issue of staff morale: "The board of trustees acknowledges the importance of listening to staff and addressing their concerns as communication is essential to the development of mutual trust and confidence."
So approximately 30 days prior to each of its bi-monthly meetings "one or more of the trustees will make themselves available to meet with interested staff at designated locations in the home."
Krawczyk during the meeting worked with members to set up the first such listening session.
Mark E Rondeau can be reached by email at firstname.lastname@example.org or on Twitter @banner_religion