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STATE OF MONTANA’S
EASTERN MONTANA VETERANS’ HOME
An Affiliate of Glendive Medical Center

Information for Prospective Residents:

We take this opportunity to welcome you to the Eastern Montana Veterans’ Home (EMVH) and to acquaint you with the policies and procedures that govern our facility.  We ask that you review the following information and encourage you to ask any questions or state any concerns you may have about our policies and procedures.

BILLING INFORMATION (9/01/2007)

Daily charges are:                                $  157.00

Billable services include:
      Veteran’s Administration pays:      $    67.71
      Veteran’s pay:                               $ 89.29    
      Plus medication:                             

Spouses’ daily charges:                       $  157.00

Daily charges are subject to change.

All daily charges must be requested and approved by the State of Montana.

Upon admission, the room charges for the current month will be due.  If you qualify for Skilled Care, insurance will be billed until Skilled Nursing is discontinued.  At that time, an invoice will be sent for the remaining days in the month. Payment is due upon receipt. 

The last week of the month, an invoice will be sent for the next month’s daily room charges.  Payment is due by the 1st of the month.  No later than the 10th of the month following admission, you will receive an itemized bill of the previous month’s pharmacy charges.  If you have enrolled in a Prescription Drug Plan, these charges have been submitted to the Plan.  If you have not enrolled in a Plan, admission into a Nursing Home is a qualifying event and we can help you enroll. 

The Eastern Montana Veterans’ Home (EMVH) has 80 beds of which 16 are specifically designed for veterans with dementia, primarily Alzheimer’s disease. EMVH is designed with fireproof construction and completely modern and up-to-date in all respects.  Every effort has been made to provide a home-like atmosphere offering comfort and privacy. 

ADMISSION POLICY:
The admission policy of Eastern Montana Veterans’ Home (EMVH), an affiliate of Glendive Medical Center (GMC), is to admit veterans who qualify under 10-2-403 M.C.A. to EMVH for skilled and intermediate Nursing Home care.  Spouses of qualified veterans will be admitted to the Nursing Home on a space available basis.

To be eligible for residence at EMVH under the regulations prescribed by the Department of Public Health and Human Services (DPHHS), a person must be an honorably discharged veteran, the spouse or surviving spouse of a veteran who served in the armed forces of the United States regardless of race, color, creed, age, gender, national origin, medical diagnosis or handicap, this admission policy is limited only by our ability to properly serve the resident.  Consideration must also be given to:

            1.         The person’s age.
            2.         The person’s physical and mental status.
            3.         The person’s ability or inability to locate suitable alternative accommodations.
            4.         The person’s term of residence in Montana.
            5.         The person’s gender as it relates to availability of appropriate living space.
            6.         The ability of the EMVH to meet the person’s needs.
            7.         Other admission requirements as may be established by the DPHHS.

ACCOMMODATIONS:
Accommodations are in semi-private rooms.  All rooms are completely and attractively furnished.  Emergency call system operates from each bed and bathroom.  Every effort will be made to assign residents to a room of their choice; however this is not always possible.  It may become necessary to move a resident because of problems relating to compatibility, level of care, or interruption with the daily routine.  In such an instance, the resident and/or responsible party will be notified as soon as possible before the move.  In case of emergency, moves will be made and notification will then be made to the responsible party.
 
Upon admission to the Nursing Home, residents are classified at one of two different levels of care:

1.  Intermediate: 
            Resident needs assistance in some areas of daily living; i.e., may require meal assistance, assistance in bathing, dressing and/or toileting, or may be incontinent, and
            The mental condition may limit independent activity or require close supervision.  Intermediate care may be covered by private insurance, private pay, or Medicaid.

2. Skilled:  After the twentieth (20th) day, the resident is responsible for a co-pay amount. If the resident is a veteran the VA will pay a portion of this amount. If the resident is the spouse of a veteran the spouse will be responsible for the co-pay amount.

  Must fall within the Medical Criteria established by the Montana –Wyoming Foundation for Medical Care. A doctor certifies you need, and actually receive, skilled nursing or skilled rehabilitation services on a daily basis. Skilled nursing services can only be provided by licensed nursing personnel. Rehabilitation services are such things as physical therapy, occupational therapy, or speech therapy. Skilled care may be covered by Medicare, a Medicare supplement, private insurance, private pay, or Medicaid.

FOR SKILLED LEVEL OF CARE:
EMVH will file all Medicare and Supplemental Insurance claims for skilled Nursing Home residents.  Private non-skilled claims are the responsibility of the resident or resident representative.  If Medicare and/or the supplemental insurance has paid, or will not pay, the resident is responsible directly to the facility for any unpaid balance upon receipt of the monthly statement.

PERSONAL FURNITURE:
We encourage residents to decorate their rooms in order to create a more homelike environment; however, due to the restricted amount of space in each resident's room, only a limited amount of personal furniture is allowed.  EMVH will make every effort to protect the resident's personal furniture.
 
PERSONAL ITEMS:
Items such as electric razors, make-up and special hair items are recommended to encourage personal grooming and neat appearance.  Such personal items are the responsibility of the resident or family to replace.  Small items such as skin lotion, toothpaste, denture cleanser, brushes, combs and facial tissue are provided by the EMVH.

CABLE TELEVISION:
TV sets with Cable TV are available for group viewing in lounge areas at no additional charge to the residents.  If requested, cable TV is also available in the resident’s room for a monthly fee.  TV sets are not provided, but residents may bring in or purchase their own TV sets.
 
TELEPHONES:
Residents may have their own personal telephones.  Arrangements for this service must be made with the telephone company by the family or resident. Residents may place and receive calls in the resident telephone room. 

VISITING HOURS:
EMVH has no established visiting hours.  Children are encouraged to visit residents provided they are in good health and are accompanied by an adult visitor.  A responsible person must sign the resident out and accept responsibility for the resident while out of the facility.

SMOKING:
EMVH is a non-smoking facility with established rules and designated outdoor smoking areas for residents, visitors and employees.  The rules, smoking areas, and limitations will be observed by all.  The resident’s smoking materials (cigarettes, cigars, pipes, matches, and lighters) will be kept at the Nurse’s Station.  Individuals will be closely supervised by staff or family during smoking periods with set smoking times. A smoking apron may be required for safety.  A schedule for smoking times will be posted at the Nurses Station.

EQUIPMENT:
EMVH provides wheelchairs, walkers, Geri chairs etc., for residents.  If a resident so chooses they may purchase their own specialized wheelchair and/or equipment.

MEDICAL CARE:
The Nursing Home meets the needs of residents who require long term care.  Care will be provided in accordance with the Nursing Home policies and procedures and State and Federal regulations.  Licensed nurses are on duty at all times.  Nurse’s aides are available to assist residents with their personal care needs.  Each resident must have a doctor of their choice who will be able to see them when necessary and who will come to the institution when needed.  Residents must be seen by their doctor at least every thirty days for the first ninety days after admission, and at least once every sixty days thereafter. 

EYE, TEETH AND EAR CARE:
Eye, dental and hearing exams are done by local professional providers. EMVH does provide the transportation & escorts to and from these appointments.  These visits will be billed to the resident from the individual practitioners.  Annual dental examinations are a requirement and will be done by our advisory dentist and/or his staff.  There is no charge for this exam.  Recommended follow-up care will be referred to your personal dentist. 

Dentures are required to have the resident’s name on them.  Ask your private dentist for the cost to mark the dentures.
Eyeglasses will be marked with the resident’s name.  We recommend yearly appointments to maintain eye health.
The purchase of hearing aide batteries is the responsibility of the resident.  The number on the hearing aide will be marked in the resident’s chart.
EMVH is not responsible for the loss or breakage of eye glasses, dentures or bridges, or hearing aides unless directly due to the facility’s negligence or as required by law.

MEDICAL APPOINTMENTS OFF-SITE:
You may choose to make an appointment to see your optometrist, ophthalmologist, dentist, audiologist, physician, etc.  Please notify the Nursing staff with the date and time of your appointment. 
Safety:
EMVH staff is committed to providing a safe environment for all residents.  Because some residents are not able to identify unsafe behaviors due to cognitive loss, we ask all residents to refrain from having scissors and pocket knives in their rooms.  Staff is willing to assist if you need fruit cut up.  You may request scissors for a project.
 Please notify staff if you have any electrical items such as lamps, TV’s, razors, radios, etc.  A safety check must be performed on the item and a safety sticker applied by our staff before the item can be used. 
No heating pads or other electrical heating units can be used.

ROOM CHANGES:
EMVH staff attempts to keep room changes to a minimum.  However, changes are occasionally necessary.  A change in the resident’s condition may necessitate transfer to or from an area offering observation, highly skilled care, or a more dependent or independent level of care.  There are times when a room change is necessitated in order to admit a member of the opposite gender.  Families or residents may request room changes.  We attempt to honor requests as rooms become available.  A room change may be necessitated if roommates are incompatible.

PERSONAL POSSESSIONS:
EMVH will hold residents personal possessions for 14 days after discharge or death.  If no arrangements are made for retrieval, the possessions will be donated to charity.

SERVICES PROVIDED

ACTIVITIES:
Trained personnel, provides a unique activity program daily, during evenings and on weekends.  These activities meet a wide variety of physical, social, and spiritual needs of the residents. Included are:  arts, crafts, hobbies, games, cards, cooking, movies, bingo, sing-a longs, outside entertainment, van outings, re-motivation, reality orientation, special seasonal programs and entertainment.  The activity staff makes a special effort to have meaningful contact on a daily basis with residents even if they cannot directly participate.

PHYSICAL AND OCCUPATIONAL THERAPY:
EMVH requires an evaluation by a physical and occupational therapist for all new admissions except in special circumstances.  In addition, the resident’s provider may order therapy at other times. A registered Physical and/or Occupational Therapist direct the individual therapy programs.   In certain cases, Medicare and/or your supplement may pay for these skilled services, but they may be private pay as well.
A daily restorative services program is offered by rehabilitation aides who work under the direction of the Therapy and Nursing Departments. 

RESPIRATORY THERAPY:
Respiratory Therapy services are provided by qualified Respiratory Therapists for residents with breathing problems when ordered by his/her health care provider. Additional charges are required for a respiratory therapist’s services which may or may not be reimbursable as dictated by Medicare regulations.  Normally, Respiratory Therapy includes determining effectiveness of oxygen delivery and assistance with breathing treatments.

PHARMACY:
A unit dose system of drug distribution is utilized in the Nursing Home.  All medications must be packaged to conform to this system.  We observe all State and Federal regulations concerning medications and drug delivery systems.
 
If you are receiving skilled services, all pharmaceuticals are provided and covered by Medicare.

If you are receiving intermediate care, you may choose to purchase your medication from GMC or an outside pharmacy as long as the Nursing Home receives them in proper packaging.  Pharmaceutical suppliers must provide 24-hour emergency call, delivery and billing.  No medications of any kind are allowed in resident rooms unless specifically ordered by a health care provider and the resident is assessed to safely self-administer medication.

Please bring medications of any type - prescription or over the counter - to the Nurses Station when admitted.   A health care provider orders your medication and he needs to be aware of all medications that you are taking.  Drug interactions can be harmful to your health.

DIETARY:
A Registered Dietitian is available for dietary counseling.  Residents are encouraged to use the dining room for all meals.  Food service, if required, is available.  All diets are arranged with the dietitian in accordance with the health care provider's diet order.  The dining room is open to visitors of all residents.  Arrangements can be made for residents and their visitors to eat in their room or in a separate area if desired.

SOCIAL SERVICES
Social Services are available to all residents.  A social service worker is available to provide assistance with financial, emotional, and personal needs.  The social service worker can also provide referral information to other community agencies.

DISCHARGE PLANNING::
The discharge potential of each resident is evaluated upon admission.  If discharge is anticipated, the interdisciplinary team members will assist the resident and family in making appropriate arrangements for discharge.

SPIRITUAL NEEDS:
Bible Study, memorial services, choirs, Rosary, and Communion are offered for those who wish to participate. The minister of your choice is always welcome to visit you at your request. 

LAUNDRY SERVICES:
EMVH is responsible for the labeling and the marking of all clothing.  GMC does the laundering for EMVH.  Families may choose to launder clothing outside of the facility.  Should an incontinent resident whose family normally launders their clothing soil an item, the clothing will be sent to GMC’s laundry.  All personal clothing from the day of admission and continuing to the day of discharge must be brought to the Nurses Station for proper labeling regardless of where clothing is normally laundered to help prevent loss. 

We discourage having any clothing on the premises that is not central laundry washable and permanent press, we do realize the necessity in some cases.   Personal clothing processed in some other manner must conform to the standards of regulatory agencies and/or the sanitary standards of Nursing Home.
The facility will not accept responsibility for the following:

           *          Dry cleaning                           
           *          Hand washing (costume stones),
           *          Clothing not color fast bonded knits, etc.
           *          Woolens                                             
           *          Any valuable clothing (fur coats),     
           *          Clothing in need of pressing.

This procedure will be followed from admission and continue to the date of discharge to insure clean personal clothing at all times and requires the cooperation of residents, guardians, friends and family.

MISCELLANEOUS:
Beautician and barber shop services are available to residents on a weekly basis for a minimal fee. 

VALUABLES:
Residents are encouraged not to keep valuables (watches, jewelry, etc.) and more than $10 in their rooms.  At your request, money can be deposited in an individual resident trust account. Money deposited in the trust account is available to you during business office hours, 8:00 a.m. to 5:00 p.m., Monday through Friday.  A safe is provided for safekeeping of valuables and money.  EMVH will make reasonable efforts to ensure the safety of the resident’s personal possessions.  The facility cannot guarantee the safety of all personal items.  Also, the facility is not responsible for loss or damage of the residents personal property unless directly due to the facility’s negligence or as required by law.  We recommend substitution of items of lesser value for watches, rings, jewelry of great sentimental or monetary value.

RESIDENT CARE PLANS:
A written resident care plan is developed on admission and is coordinated by Nursing Service in cooperation with the physician, Registered Dietitian, Activity and Social Services staff.  The Plan of Care is a working tool which provides a profile of the needs of each resident.  The plan identifies each department's role in meeting these needs and supportive measures each department will use to accomplish the overall Plan of Care.  The Plan of Care is reviewed quarterly and is updated as needed.  Residents and families are encouraged to participate in the development of this plan.  Families will receive a letter of invitation informing them of the date and time to attend.  You are encouraged to call the phone number on the invitation to confirm your appointment.

RESIDENT COUNCIL:
As a resident of EMVH, we encourage all residents to attend Resident Council.  Council is to provide residents a forum in which they feel free to discuss and share problems, grievances, etc.  The Council may request meetings with staff, conduct resident surveys, write letters to the administrator or seek to identify and work out problems related to the facility.  Your opinion is important!  Use this Council to have your voice heard.

SUPPORT SERVICES:

Alzheimer Support Group:
An Alzheimer Support Group is available for friends/families of persons affected by Alzheimer’s disease or related dementia.  Contact Social Services, Activities, or Nursing Staff for the time and place of meetings. 

BED HOLD POLICY:

A.  Hospitalization/Medical Services outside EMVH Nursing Home

A bed will be held in the EMVH Nursing Home for Medicaid eligible residents in the case of hospitalization.  In situations where conditions of billing for holding a bed are not met, providers must hold the bed and may not bill Medicaid for the bed hold day until all conditions of billing are met and may not bill the resident under any circumstances.  At the time of transfer of a resident for hospitalization, EMVH will provide to the resident and/or a family member or legal representative information about the bed-hold policy. Private pay residents will continue to be charged the room rate if they choose to hold a resident’s bed while he/she is hospitalized. 
A resident whose hospitalization exceeds the bed-hold period under the State plan, as stated above,  is re-admitted to EMVH immediately upon the first availability of a bed in a semi-private room if the resident:
            1. Requires the services provided by the facility
            2. Is eligible for Medicaid nursing facility services

B. Therapeutic Home Visits for Medicaid Residents

A bed will be held in EMVH Nursing Home for residents in the case of a therapeutic home visit for 24 days, per resident in each rate year (July 1 - June 30).  If the resident desires days in excess of 24, other financial arrangements must be made with the facility.  Temporary absences which are of indefinite duration as well as the anticipated duration of absence must be documented at least weekly to assure that the absence is indeed temporary.  Therapeutic home visits may be used for trial placement in the home and with community service.  EMVH will provide to the resident and/or a family member or legal representative information about the bed hold policy.

Requirements for therapeutic home visits:   The resident’s Plan of Care provides for therapeutic home visits. The resident may be absent from the facility for no more than 72 consecutive hours per absence unless a longer absence is deemed medically appropriate.  The Department of Public Health & Human Services Senior & Long Term Care Division must authorize the longer absence in for Medicaid residents. A request for a therapeutic home visit bed hold must be submitted to the DPHHS Senior & Long Term Care Division on the appropriate form provided by the Department within 90 days of the first day a resident leaves the facility for a therapeutic home visit.

A resident whose therapeutic home visits exceed the bed-hold period under the State plan is re-admitted to EMVH immediately upon the first availability of a bed if the resident:
            Requires the services provided by the facility.
            Is eligible for Medicaid nursing facility services.

TRANSFER AND DISCHARGE OUTSIDE GLENDIVE MEDICAL CENTER:

Residents may not be transferred or discharged from EMVH unless it is:

1        Necessary for his/her welfare and his/her welfare cannot be met in the facility.
2        The resident no longer needs the services provided by the facility.
3        The health or safety of individuals in the facility is endangered.
4        Failure, after reasonable and appropriate notice, to pay for (or to have paid under Medicare and    Medicaid) his/her stay at the facility.                    
5        The facility ceases to operate.

Before a transfer or discharge is made, EMVH will notify the resident. A family member or legal representative will also be notified in writing of the transfer /discharge and the reasons for it if contact information is provided.   
The written notice will include:

• the reason for transfer or discharge
• the effective date of transfer or discharge
• the location to which the resident is transferred or discharged
• a statement that the resident has the right to appeal the action to the  Office of Fair Hearings.
• the name, address, and telephone number of the State Long Term Care Ombudsman

For residents with developmental disabilities the mailing address and telephone number of the agency responsible for protection and advocacy of developmentally disabled individuals, for residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals.

EMVH will provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.

If the transfer or discharge is involuntary, the resident has the right to 30 days advance notice to ensure an orderly transition, except in cases of emergency, for medical reasons, to protect the health or safety of individuals in the facility, or if he/she has not resided in the facility for 30 days.  EMVH will inform the resident of his/her appeal rights relating to transfer or discharge decisions.

Documentation of transfers and discharges must be made in the resident's clinical record by the resident's health care provider and also in the nursing notes.  The reasons for the transfer or discharge must be recorded in the clinical record.

RESIDENT FUND MANAGEMENT POLICY:

1.         The resident has the right to manage his/her financial affairs.  EMVH does not require residents to deposit their personal funds with the facility.
2.         Upon written authorization of a resident, EMVH will hold, safeguard, manage and account for the personal funds of the resident deposited with the facility.
3.         Deposit of Funds:
            a.         Funds in excess of $50 - Funds will be deposited in an interest-bearing account that is separate from any of the facility's operating accounts and will credit all interest earned on the resident's  funds to that account.  There is a Nursing Home Trust Account in the bank with a separate accounting for each resident's share.
            b.         Funds less than $50 - Funds will be kept in an interest-bearing account.  These funds will be kept in the Business Office.  The resident will have access to such funds upon request.
4.         Accounting and records - A full, complete and separate accounting will be kept of each resident's personal funds entrusted to the facility on the resident's behalf.
            a.         There will be no co-mingling of resident funds with facility funds or with the fund of any person other than another resident.
            b.         The individual financial record will be provided through quarterly statements, and also upon receipt of a request of the resident or his/her legal representative.
5.         Notice of certain balances - EMVH will notify each resident that receives Medicaid benefits:
            a.         When the amount in the resident's account reaches $200 less than the SSI resource limit for one person and

            b.         if the amount in the account in addition to the value of the resident's other non-exempt resources                                     reaches the SSI resource limit for one person; the resident may lose eligibility for Medicaid or SSI.
6.         The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under Medicaid or Medicare except for applicable deductible and coinsurance  amounts.
7.         Conveyance upon death:
            The facility may satisfy a debt owed by the deceased resident to the facility from the deceased resident’s personal funds that are held by the nursing facility and would have been payable to the facility from those funds.  This will not include any amount for which payment is to be made under Medicare or Medicaid except for applicable deductible and coinsurance amounts.
           
            If the resident has a surviving spouse, minor child or a disabled adult child and received Medicaid benefits, or if the resident had not received Medicaid benefits at any time during their stay at this facility, the funds will be paid to the resident’s estate within 30 days following the resident’s death.  In those cases, the funds will be subject to the probate code.

            Any remaining funds in the deceased resident’s personal fund after satisfying 7a and 7b, will be refunded by this facility within 30 days following the resident’s death to the Third Party Liability Unit, Department of Public Health and Human Services, P.O. Box 202953, Helena, MT 59620-2953 if that resident had received Medicaid benefits at any time during their stay at this facility.

TRANSFER OF RESIDENT TO AND FROM DOCTOR'S OFFICE:

All physician visits will be provided to residents on site.  In the event the physician visit cannot be done in the facility, EMVH will encourage the resident's family to make the appropriate arrangements, including transportation.  If no family member is available, EMVH will provide staff and/or volunteer escort to assist these residents.

An ambulance will be utilized to transport the resident to the hospital under the following conditions:

• the onset of an acute illness
• any type of bodily injury
• exhibits symptoms that require an Emergency Room visit or
• upon return from hospital stay when other transportation is unavailable.

Public transportation will be utilized for doctor, dentist and optometrist appointments, Outpatient services, i.e., x-rays, cardiac rehab or lab or a return to EMVH from a hospital admission if the family is unavailable and the resident’s health condition is stable.

The health care provider is required, according to Medicare and the Montana Department of Public Health and Human Services regulations, to visit his/her Nursing Home residents regularly.  EMVH encourages the health care provider to perform any required treatments and/or procedures necessary for a resident during these routine visits.

Consents for any procedures done in the health care provider's office are the responsibility of the health care provider.

RESIDENT AND FAMILY/GUARDIAN RESPONSIBILITIES: 

It is the responsibility of each resident admitted to this facility to:
1.         Provide, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his/her health.
2.         Report unexpected changes in his/her condition to the responsible health care provider or nursing staff.
3.         Make it known whether he/she clearly comprehends a contemplated course of action and knows what is expected of him/her.
4.         Participate in the Plan of Care recommended by the health care providers primarily responsible for his/her care.  This includes following instructions of nurse and health professionals as they carry out the             coordinated Plan of Care and implement the responsible  health care provider's orders, and as they enforce the applicable facility rules and regulations.
5.         Accept responsibility for his/her actions if he/she refuses treatment or does not follow the health care provider's instructions.
6.         Assure that the financial obligations of his/her health care are fulfilled as promptly as possible.
7.         Control his/her own behavior and be considerate of other resident's rights (example: noise, smoking)
8.         Be respectful of the property of other persons and of the facility.

Give their pharmacy a 48 hour notice if he/she plans to be out of the Nursing Home for more than 12hours.  If he/she plans to be out of the facility less than 12 hours, he/she needs to give the Pharmacy a 2 hour notice.

RESIDENT GRIEVANCE PROCEDURE

If you have a concern or grievance that you feel needs to be considered we ask that you follow the guidelines listed below.  EMVH believes good care is your right and is committed to resolving grievances in an equitable manner.

1.         Please make your grievance as specific as possible.  If you wish, you may make your concern a written one.  You and/or your family may report concerns, incidents or grievances without the fear of   retribution.
2.         The grievance should be presented to the charge nurse on duty.  If the matter cannot be satisfactorily resolved with the charge nurse, the next step would be to present the complaint to the Director of Nurses or Social Services staff.
3.         If you are not completely satisfied at this point you may meet with the EMVH Administrator to discuss the matter and seek a fair solution.
4.         In addition, the Certified Local or State Long Term Care Ombudsman is available for problem mediation.

EMVH will make reasonable efforts to ensure the safety of the resident’s personal possessions.  The resident acknowledges that the facility cannot guarantee the safety of all personal items and is not responsible for loss or damage of said items unless directly due to the facility’s negligence or as required by law.  We recommend watches, jewelry or other items be substituted with items of lesser value.  If you desire to have money easily accessible for the resident, money can be deposited in a resident trust account in the Administrative Office.