Missouri Veterans Case Study

What We Did

• • HMS conducted a mock survey process and recommended that MVC Veterans Homes hire infection control specialists to create, implement, and oversee infection control programs in the Veterans Homes. This is not something that previously existed on such a large scale.
  • Because the MVC listened to our recommendation and implemented this program, they were able to act quickly during the pandemic and limit their deaths to 1 out of 1,100.
  • HMS can confidently say that we were able to help the MVC save lives during this global pandemic.

Background

• • In April 2018, the MVC contacted HMS. One of their seven homes had become the focus of substantial media attention. Even though the homes had received fair marks on their federal VA inspections, the services being provided at the facilities were not satisfactory to the new MVC leadership, the veterans, or their families.
  • The Governor had previously engaged a company to inspect SVHs, but the inspection did not yield the results they were hoping for. The inspection was more of a risk analysis and didn’t provide a true picture of the issues in the homes.
  • In their continued effort to be responsive to stakeholders and increase quality, the MVC then engaged HMS to perform a mock survey using the Centers for Medicare and Medicaid (CMS) regulations for long-term care (LTC) (nursing homes) as the basis for the survey. The MVC wanted help uncovering any and all issues that must be resolved to ensure the veterans receive the best care possible.
  • HMS performed the survey on the single home utilizing the CMS’ current long-term care regulations and following the traditional survey methodology. The CMS care areas reviewed as part of the process included topics such as abuse and neglect, nursing services, and infection control.
  • The mock survey process included but was not limited to; family, staff, and veteran interviews; observations on all three shifts; veteran record review, review of facility policy and procedure, and a human resource review that included verification of required/needs based training and license/certification reviews.
  • After performing the first mock survey for the MVC, another contract was initiated to complete mock surveys on all seven MVC Veteran Homes.

Our Findings & MVC’s Response

• • Following each survey, HMS provided a report that included detailed findings for any areas that may have been found non-compliant according to the Code of Federal Regulations (CFR) and recommendations for addressing these findings for each specific care area. A high-level comparison of any identified concerns and corresponding regulatory sections were identified for each of the seven SVHs and provided to the MVC executive director for review.
  • Following submission of these findings, the MVC created and implemented action plans to address concerns related to potential non-compliance identified during the mock survey. These included quality improvement activities related to CMS standards. These various initiatives held the homes to a new higher standard of practice. Looking at the homes using the CMS standards allowed the MVC to compare their homes with certified nursing homes and common areas of concern, globally.
  • These mock surveys were the first time the homes were evaluated using the CMS LTC regulations and demonstrated the MVC’s core value of excellence in all they do.
  • Since the reports provided areas of concern and non-compliance, each home had a road map to improve the quality of care for their residents and continue to strive for protecting our most vulnerable.

HMS Demonstrated Value

• • The MVC was so pleased with the initial survey and the subsequent report, that they asked HMS to continue their work, completing two subsequent revisits and two additional reports for that one facility. The reports clearly outlined where gaps were present in the provision of services. An exit conference was held for each survey and the facility staff was able to ask questions and discuss resources and recommendations for improvement, so they were able to put a corrective action plan in place.
  • The impact HMS had on this first facility was so positive, that MVC then engaged HMS to complete mock surveys on all seven of their homes. Over the next two years, HMS completed those surveys and provided recommendations for quality improvements.

Agencies Involved

• • Missouri Veterans Commission (MVC): The MVC is a state agency established to aid all veterans, their dependents, and legal representatives by providing information regarding the rights of veterans and their dependents and to assist veterans accessing their available benefits through state and federal government. The vision of MVC is to provide high quality, compassionate care for veterans; seamlessly integrated with the veteran community; emphasizing a culture of transparency and excellence.
  • Department of Veterans Affairs (VA): The VA is the federal regulatory body responsible for survey procedures for state veterans homes. The goals of the survey policies are to help ensure the homes are performing according to VA regulations and to ensure eligible veterans are safe and receiving the best quality of care.