SUMMARY OF BENEFITS FROM 1. FREED UP OVER 3.75 MILLION DAYS OF HOSPITAL CARE BY PROVIDING NURSING HOME CARE. 2. ONE MILLION SQ. FT. OF SPACE HAS BEEN OR SHORTLY WILL BE MODERNIZED, EQUIPPED, AND FURNISHED TO ESTABLISH 4,000 VA NURSING HOME CARE BEDS AT A COST OF LESS THAN $10 MILLION. 3. IMPROVED STANDARDS FOR NURSING HOMES: a. WITHIN VA. b. WITHIN COMMUNITY (CONTRACT) NURSING HOMES. C. WITHIN STATES SOLDIERS' HOMES. 4. IMPROVED LIFE SITUATION BY PROVIDING APPROPRIATE CARE AND ENVIRONMENT FOR 20,000 VETERANS NEEDING NURSING HOME BENEFITS. 5. RESTORED OVER 2,000 VETERANS TO PRODUCTIVE LIFE THROUGH RESTORATION PROGRAMS. 6. ASSISTED STATES IN CONSTRUCTION OF 824 NURSING HOME BEDS IN PROJECTS COSTING $11 MILLION. 7. CONSERVED SCARCE HEALTH MANPOWER. CHART XXXI ONGOING GOALS 1. INCREASE OUR COOPERATIVE EFFORT WITH DEPARTMENT OF DATA MANAGEMENT TO: a. PRODUCE DOMICILIARY PATIENT TREATMENT FILE. b. PRODUCE COMMUNITY NURSING HOME CARE TESTING AND QUALITY CONTROL. 2. CONTINUE TO PLAN WITH EDUCATION AND PERSONNEL SERVICES IN DM&S 10: 2. ORGANIZE EDUCATIONAL PROGRAM IN ADMINISTRATION AND TECHNOLOGY OF LONG TERM CARE. b. PROVIDE FOR MASTER'S DEGREE IN HOSPITAL ADMINISTRATION WITH EMPHASIS ON CHRONIC CARE FOR VA PERSONNEL AT GEORGE WASHINGTON UNIVERSITY. 3. UTILIZE ADVISORY COUNCIL FOR CONSONANCE WITH PROFESSIONAL, VOLUNTARY AND OTHER FEDERAL AGENCIES IN EXCHANGE OF IDEAS. 4. PLAN FOR CREATION OF ADDITIONAL NURSING HOME BEDS WITHIN VA IF NECESSARY OR DESIRABLE. 5. CONTINUE TO ESTABLISH RESTORATION CENTERS AT ALL DOMICILIARIES AND SELECTED HOSPITALS WHERE FEASIBLE. CHART XXXII NURSING HOME CARE COSTS The per diem cost for care of VA beneficiaries in community nursing homes has been set by law to be a maximum of one-third the per diem cost rate in the VA general hospitals. This cost originally had been set at $10.50. It has become necessary to adjust this per diem rate to $11.50 effective January 1, 1967 to prevent cancellation of community nursing home agreements because the rate was too low. Effective July 1, 1967 the maximmu per diem cost will be raised to $12.00 which should further assist in reducing the number of cancellations of agreements and assist in making new ones. For the first nine months of fiscal year 1967, the reported average per diem cost of all VA nursing homes amounted to $14.40. It is expected that the per diem cost for patients placed in the VA nursing home care units would be higher than those in the commnuity nursing homes because the former patients require a greater degree of professional and health services than do the patient placed in the community nursing homes. These are patients who have received maximum hospital benefits but whose condition is such that they have little potential for any kind of outplacement. However, patients placed in the community nursing homes can reasonably expect to be discharged from the nursing home within six months. The present accounting system, when applied to an expanding program such as is the VA nursing home care program considers the initial cost of supplies, equipment and staffing as chargeable to the current cumulative patient load. Although the VA nursing home per diem cost is expected to be higher than that of the community nursing homes, our present accounting system shows a disproportionate share of the costs to the patient loads. The VA is presently studying the cost factors applicable to the operation of the VA nursing home. DM&S Circular 10-67-120, May 20, 1967 provides for the reporting of all costs chargeable to VA nursing home care units during the week of June 11 through June 17, 1967. The reports are due in the week of June 20, 1967. When summarized, an analysis will be made which will form the basis of establishing a suitable cost reporting system for this program. The reporting instructions and the report form are attached. A table showing the comparison between the reported costs of VA and community nursing home care since July 1, 1965 is also attached. At the present time the amount of the VA's contribution to State nursing homes is $3.50 per day. However, proposed legislation, H.R. 3045 90th Congress, provides for an increase to a maximum of $5.00 per patient per day. CIRCULAR 10-67-120 VETERANS' ADMINISTRATION, DEPARTMENT OF MEDICINE AND SURGERY, Washington, D.C., May 29, 1967. Subject: Nonrecurring report of personnel and costs in VA nursing home care units, June 11-17, 1967, RCS 11-22-S. To: Directors, selected VA hospitals with nursing home care units. 1. Purpose. The purpose of this report is to determine what the appropriate staffing and costs should be for the VA Nursing Home Care Units (NHCU.) 2. Preparing Office. The report on VA Form 10-20380 (NR) will be prepared by all VA stations having a VA NHCU, program 853 under the Medical Care Appropriation. 3. Report Period. The report will be prepared for seven day period June 11 through June 17, 1967. 4. Frequnecy and Due Date. An original and two copies of VA Form 10-20380 (NR) will be prepared. The original and one copy will be forwarded to reach Central Office (042B21) no later than June 20, 1967. The station will retain one copy. Distribution of the report form is being made. 5. Instructions for Preparation of VA Form 10-20380 (NR): a. General. For the purpose of this report, hours and costs will be obtained by direct costing procedures. The factors used to develop costs of programs 853, found in the official accounting procedures reported in Schedule A, Part I, of the cost accounting reports, will not be used except where necessary to provide the answer for any item on VA Form 10-20380 (NR). Where it is not possible to clearly identify personnel hours and costs associated with the NHCU for particular functions, the station's best estimate will be provided. For example : In the Dietetic Service, dietitians, cooks, bakers, etc., are engaged in the preparation of food in one kitchen for the total hospital and it is not possible to identify these personnel specifically to NHCU patients. An estimate of the time and costs for line 11 will be acceptable. b. Line Instructions: (1) Lines 1 through 6. Concern personal service costs only. Lines 1 through 3 concern physicians only charged to cost centers 201, 202 and 203 respectively. Lines 4 and 5 concern professional nurses and LPN/NA's only charged to cost center 241. Line 6 concerns social workers charged to cost center 221. All other personnel charged to these cost centers will be reported on line 18. (2) Lines 7 through 15. The entries on these lines should relate to the cost centers in DM&S Appendix B, MP-4, Part V. (3) Lines 16 and 17. The entries on these lines should relate to the cost centers 401 through 441 and those in the 500 series except housekeeping and laundry, 561 and 562. These data are required for this report even though the requirement for excluding them in the regular cost accounting system prevails. (4) Line 18. Include all other personal services and costs as appropriate not identified (such as those pertaining to library and psychology) or restricted above. On the reverse side of the form identify the type of hours and costs included. (5) Line 19. The patients in the NHCU will be classified according to their nursing needs in the manner required for reporting on AMIS segment 200, fields 21 through 24. (6) Line 20. Enter the number of operating beds in the NHCU as of June 14, 1967. (7) Line 21. The average daily nursing load (ADNL) for the week of the report will be shown on this line. The ADNL is obtained by adding the number of patients remaining in the NHCU each day of the report period and dividing by 7. c. Column Instructions: (1) Col. A. Full-Time hours. Full-time personnel who devote full-time to the NHCU will be reported as 40 hours each under Column A regardless of any leave or days off during the report period. Example: There are four full-time professional nurses who devote full-time to the NHCU. The entry in Column A, line 4, will be 160 (4 times 40). (2) Col. B. Other Hours. The hours of personnel devoting part-time to the NHCU will be counted on the basis of actual hours spent. Example: A professional nurse assigned to the medical bed section of the hospital spent 10 hours and another nurse assigned to the admitting office spent 15 hours of their time in the care of NHCU patients. The entry under column B, line 4, would be 25. (3) Col. C. Personnel Cost: (a) For personnel hours reported in Column A add the annual salaries of each person and divide the result by 52. Thus in the example for col. A, the annual salaries of the four nurses are $6730, $7178, $7178 and $7696 or a total of $28,782. The total ($28,782) divided by 52 equals $554. The amount $554 will be added to the computation of costs for the column B hours (see (b) below) and the total costs entered in column C. (b) Personnel cost for the hours reported in column B will be computed by multiplying the hours worked by each person times their annual salary and dividing the product by 2080. Thus in the example for column B if the annual salary of the medical bed section nurse is $8740 and the admitting office nurse $7402, then : (10×8740)+(15×7402) ___ 87,400+111,030 2080 = 2080 198,430: $95 The entry in column C would be $649, that is, $554 plus $95. (4) Column D Other Costs. Enter in this column Non-personnel costs such as prescriptions and line items under pharmacy: ration costs under dietetics; heat, light under engineering, etc. 6. Any questions concerning this report should be directed to Central Office (10E2), telephone extension 3897 or 3932. Distribution: COB: (10) only SS (10C5) FLD: Selected Stations-5 ea. OREN T. SKOUGE, M.D., Deputy Chief Medical Director. |