Rhode Island Veterans Home Study shows changes needed

(At 4:30pm, the RI Department of Veterans Affairs released this news release and a link to the TIGER report – see below).

SUMMARY of Study by Alvarez & Marsal:

Alvarez & Marsal was engaged to provide the leadership of the Rhode Island Veterans Home Community Living Center with an overall risk assessment and series of recommendations in staffing, operations, labor expense control for Nursing Services, Dietary Services, and Environmental Services. Our high-level review was based on a series of interviews with key leaders along with an evaluation of presented documents, including current financial reports, publicly available quality data and various policies and procedures.

We have identified several areas for operational improvement. For these initiatives to have a sustainable impact it will require establishing a common understanding of the issues and an agreement by leadership on the prioritization of the concerns – this will be critical in accomplishing the necessary changes.

NURSING

Risk Summary:

• With the current use of a fixed staffing model for the neighborhoods, the lack of clear job delineation for licensed and non-licensed staff, ongoing daily vacancies without accountable time and attendance policy, and the absence of a strategy for recruitment and retention of staff – RIVH has inflated salary costs and struggles to maintain staffing ratios.

• Centralization of Human Resources has created gaps within the organization.

o Absence of a strategy for recruitment and retention of staff.

o Ongoing daily vacancies without an accountable time and attendance policy.

• Monitoring and tracking staffing on paper is unsustainable and inhibits the rapid ability to provide reports for review, and real time correction of over staffing by shift.

Recommendations:

• Move from a fixed based staffing model to a true acuity based staffing matrix. Neighborhoods would be ranked by acuity criteria and staffed accordingly. For residents with variable needs this would allow management to provide the right staff competences to each resident and would give management a transparent examination of labor costs to control costs on a daily basis.

• Provide the training and IT tools necessary to ensure managers can manage time and attendance compliance.

• Conduct a “zero based” budget exercise to remove the historical expectations of expenses.

NUTRITION SERVICES Risk Summary:

• Currently the Nutrition Services department operates with a high cost model with centralized and non- centralized staffing and food delivery.

• The department lacks the required FTE’s to cover 7 days a week resulting in back filling with overtime. o Use of premium labor was >$500k in 2019 (overtime).

• There is no tracking system to identify or eliminate waste. • Dietary planning and inventory control software not being utilized. Recommendations:

• Right-size dietary staffing to reduce reliance on overtime.

• Opportunity for a pilot program centralizing the galley for 4 neighborhoods as there are two restricted neighborhoods that continue to utilize a local kitchen.

• Implement food service technologies to manage and streamline inventory.

• Conduct a “zero based” budget exercise to remove the historical expectations of expenses.

ENVIRONMENTAL SERVICES Risk Summary:

• The new location added 143,000 square feet and 92 resident rooms (not all occupied) at an additional cost of $948K.

• The janitorial contract currently operates a fixed staffing model. Recommendations:

• The contract can be put out for rebid and converted to variable staffing model to reduce labor costs.

• Costs can be reevaluated by daily cleanable and non-daily cleanable space.

• The contract should reflect national benchmark costs and productivity targets such as:

         o Standard resident room cleaning –10 to 12 minutes.

         o Terminal cleaning –20 to 25 minutes.

         o Common areas, floors and surfaces-20 to 30 mins per 1000 sq. ft. /day.

         o Office space –12 minutes (12 by 12 room).

Conclusion:

Our assessment and recommendations will be most effective if they are reviewed with executive leadership and ultimately state administration. We strongly urge Rhode Island Veteran’s Home leaders to review our assessment of the risks and associated scoring and draw their own conclusions. This process, once completed, provides a strategic platform for leadership to develop a consensus around the prioritization and potential impact of the adverse outcomes. A joint, strategic response can then be developed to address each of the most critical risks and can be used as a development tool for the strategic plan as well as a key input for the annual operating plan. These plans and related progress should be evaluated on an ongoing basis.

To read the full report: https://bit.ly/3aaAdxA

Paul Murgo named as interim Veterans Home administrator

Bristol, R.I. – The state appointed an interim administrator to the RI Veterans Home today and announced it will begin adopting recommendations from an interagency team that studied the Home’s operations earlier this year. Led by members of the RI National Guard, the team released a report today that outlines several cost-cutting initiatives, ranging from renegotiating the Home’s housekeeping contract to reining in overtime costs.

The Office of Veterans Services appointed Paul Murgo, who has extensive health care administration experience, as the Home’s temporary administrator. Murgo will run the facility and be charged with implementing reforms, while the state searches for a permanent replacement for General Rick Baccus, who announced in January that he is stepping down.

Murgo will work closely with the Executive Office of Health and Human Services and the Department of Administration, among other agencies.

“I’m pleased to have someone of Paul’s experience and skillset be part of what has become a truly collaborative approach to right-sizing the Veterans Home. I have no doubt that, together, we can make this beautiful facility financially stable and sustainable for generations to come,” said Kasim J. Yarn, director of the Office of Veterans Services.

The Rhode Island National Guard’s Adjutant General, Major General Christopher P. Callahan, led an interagency review team of National Guard members and several other state employees who have expertise in budgeting, organizational leadership, and contracting, among other areas. A consultant with a health care administration background was part of the review as well.

“Our charge was to make recommendations that will stabilize spending and streamline operations without impacting the high level of care and quality of life that residents enjoy at the Home,” said General Callahan.

The team’s report focused on three areas with the greatest potential for short- and long-term savings: staffing, dietary operations and environmental services. Among its findings, the team stated the Home could benefit from renegotiating its housecleaning contract and increasing staffing levels to reduce a reliance on overtime and contracted labor.

Starting immediately, state employees from the Department of Administration will be assigned temporarily to the Home to evaluate human resources needs and assist in implementing recommended management policies. In addition, EOHHS staff and state information technology support will be dispatched to assist the Home’s finance, clinical, and dietary teams in using available management software.

Director Yarn said additional steps will be taken in coming months as Murgo evaluates the needs of the Veterans Home.

The state’s Office of Management and Budget has evaluated the recommendations delivered by the interagency team and endorsed its proposals, stating that the recommendations will position the Home to achieve savings in the Governor’s FY21 budget proposal.