Commonwealth of Massachusetts

Department of Veterans’ Services

Soldiers’ Home in Holyoke

Committed to continuous improvement

December 20, 2017

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 The Holyoke Soldiers’ Home: Background

• The Soldiers’ Home in Holyoke (HLY) operates a 247-bed long term nursing care facility with 24-
hour licensed nursing staff and a 30-room domiciliary.
• HLY provides quality “Care with Honor and Dignity” to our state’s Veterans.
• HLY is fully accredited by the Joint Commission on Accreditation of Healthcare Organizations and
inspected annually by the federal Department of Veterans Affairs (VA).
• Last received full accreditation from the Joint Commission in June 2016, with the next
scheduled certification in 2019.
• The VA conducted its annual survey in January 2017.
• HLY currently employs 339 total employees (292.5 full-time equivalent employees).
• Employees are represented by six bargaining units, each having independently negotiated
benefits packages, scopes of work and scheduling policies.
• HLY nursing care far exceeds the 2.5 hours of care per Veteran required by VA regulation.

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 Introduction

• As part of the Soldiers’ Homes’ continued commitment to supporting staff and providing the highest
level of care to its residents, on Monday, September 25th a team of experts in the fields of long term
care, geriatric medicine and health care quality conducted a high level clinical and management
review of the Holyoke Soldiers Home.
• The experts included:
• Alice Bonner, PhD, RN, the current Secretary of Elder Affairs and a nurse practitioner
specializing in geriatrics and falls prevention
• Dr. Randi Berkowitz, MD, a practicing geriatrician
• Eric Sheehan, JD, the current Director of the Department of Public Health’s Bureau of
Healthcare Quality and Veteran
• The team:
• Conducted a robust review of national and state-level surveys related to long term care
services for veterans,
• Reviewed internal data from the Soldiers’ Home including clinical data, human resources
staffing trends, and staff grievances,
• Spent 11.5 hours on site meeting with management, supervisors, nursing staff, and
clinical staff, including, staff from pharmacy, maintenance, housekeeping, dietary and
admissions, and
• Toured the facility, including the domiciliary facility, and conducted medical chart reviews. 3
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 Introduction

The result of the review identified five areas of focus to improve the care for veterans:
1. Communication and Transparency
2. Teamwork
3. Quality assurance performance improvement
4. Complaint Process
5. Family engagement

As part of Superintendent Walsh’s commitment to continued improvement to provide the best care to the
Home’s residents, over the next 12 months, he and his senior leadership team will work collaboratively
with staff to implement the recommendations of the expert group. HLY has started to implement many of
these recommendations over the past two months.

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 Improve Communication and Transparency

• Bulletin Boards will be installed and consistently updated to keep employees, veterans and
families apprised of key events, information, and upcoming meetings.
• General Information board will be installed on the first floor for upcoming events, meetings
and recent news. Residents’ rights and the complaint process will be posted on this board.
• Employee specific boards will be placed in the staff lounges to provide information to
employees . All proposed changes in policies (i.e. HR policies, vacation policies, clinical
policies) will be posted prior to implementation; allowing employees an opportunity to provide
input. The employee complaint process will also be posted.
• A Veteran and Family specific board will be installed to publish information about upcoming
events and important family meetings, such as the family advocacy council. Residents’ rights
and the complaint process will be posted on this board.
• Quarterly Staff Meetings - Superintendent Walsh and Director of Nursing Randy Stone will host
quarterly town hall meetings for each shift. An agenda for the meeting will be posted on the
employee specific boards in advance and a portion of the meeting will be dedicated to listening and
addressing employee concerns. In progress.
• Coffee with the Superintendent - Superintendent Walsh will host weekly walk-in hours to allow
staff an opportunity to raise issues and concerns on an individualized basis. In progress.
• Monthly All-Staff Communication – Superintendent Walsh will send the entire Soldiers’ Home
team a monthly communication to keep staff informed about recent changes, accomplishments and
other news. In progress.
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 Teamwork

• Senior leadership will continue to work with bargaining units to address the high rate of
employee absenteeism. In progress.
• There are approximately 400 unexpected absences a month and as many as 8 “call-
outs” on the evening weekend shift. This results in mandatory overtime and impacts
vacation leave and other requests.
• The Home will collaborate with the Executive Office of Health and Human Services Human
Resources Department to improve and expedite the hiring process. In progress.
• Since September 25th, 8 CNAs and 3 LPNs have been hired and additional direct care
positions are in the pipeline to be hired.
• Current staffing and forecast models for each unit will be analyzed to develop a
comprehensive staffing and hiring plan. In progress.
• State-wide HR recruitment strategies will be broadened through collaboration with external
workforce entities and state partners such as the Executive Office of Elder Affairs and the
Executive Office of Labor and Workforce Development.
• The Home will administer a Culture of Safety Survey to all staff to understand their view of
the Soldiers’ Home’s work environment and inform strategies to target areas of concern. In
progress.

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 Quality Assurance Performance Improvement Plan

• The Home will hire and work with a consultant to support management in implementing a
systematic, comprehensive, and data-driven approach to maintaining and improving patient
safety and quality. In progress.
• Implement a Quality Assurance Performance Improvement (QAPI) plan that will focus
on clinical quality and safety and audit processes to assess and track progress.
• The Home will utilize data from the existing call system to track response times, conduct
QAPI audits and improve processes related to preventing falls and promoting mobility. In
progress.
• The Home will review falls protocols with a falls expert to ensure a comprehensive and
systematic approach to falls prevention. In progress.
• The medical director will join and participate in Massachusetts American Medical Director
Association (AMDA) meetings to learn and share best practices. Complete.
• The Home will join the Western Massachusetts Nursing Home Culture Change Coalition
to benefit from best practices in long term care and aging services utilized by Coalition
members. Complete.

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 Complaints: Our opportunities for Improvement

• The Soldiers’ Home recognizes that a credible complaint process provides an important
opportunity to improve our level of service for our residents.
• A new process for employees to file complaints, concerns, and suggestions will be
developed by a team of direct care staff.
• The new process will ensure that all comments are logged and maintained for quality
assurance purposes. A response and proposed corrective action will be sent to the
author, with a point of contact for follow up identified. In progress.
• Client Complaints and Family Complaints should continue to be submitted through the
suggestion box.
• All comments will be logged and maintained for quality assurance purposes. A
response and proposed corrective action will be sent to the author within 10 days, with
a staff contact for follow up. A quarterly report of complaints and responses will be
reviewed at the quarterly town hall meetings. A follow-up process will verify that the
concern has been resolved. In progress.

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 Family Engagement

• Superintendent Walsh and Director of Nursing Randy Stone will attend:

• Family advocacy meetings which are held on the first Monday of every month at 1 PM.
• Veterans advocacy council meetings, held on the last Tuesday of every month at 9:30 AM.
• Evening events, entitled “Evening of Care” family forums, are currently held twice a year. A
planning group of employees and veterans will form to discuss additional opportunities to
engage families.
• The Home will arrange for additional evening family advocacy meetings to accommodate the
schedules of working families.

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 Addressing Additional Concerns

• An air quality test will be conducted to address concerns raised by staff. Complete.
• Some staff have indicated that the process of texting employees to fill open shifts is not
equitable. The Home has resumed manually posting open shifts for all employees to sign-up
for shifts and consider other options in the future. Complete.
• An electronic medical record system and an electronic medication administration record will
be explored. In progress.
• Improve Training Opportunities:
• Provide additional leadership and management training for supervisors to improve
workplace relationships and morale. In progress.
• Provide additional staff development trainings on topic areas that support professional
growth and better equip staff to serve the unique needs of veterans and various military
cultural groups.

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