Statewide Relations

Education plan

This is a test.

Meeting Number: 1
Meeting Date: Wed. 8/11/10
Time: 1:00pm Location: TSP Office

Attendees:

AEL, Inc.
City of Sheridan
Vista West Engineering
TSP
Doug Osborn
Jason Baker
Jeff Fleck
Del Acker
Keith Wilson
Ron Callantine

Old Business

Review of Previous Meeting’s Minutes: Not Applicable (this is the first scheduled meeting)

Action Items still to be completed (Description and Person/Entity Responsible): Not Applicable (this is the first scheduled meeting)

New Business

Del –Progress on plans to date-Revised Floor Plans available now.

Working on 90% plans for review –Scheduled for 9/21/10

Discussion on Fire Sprinkler in Administration Building -Decision is Fire Sprinkler not required by
Fire Code- Therefore the Administration Building will not have a Fire Sprinkler System

Jeff – Handed out schedule revisions for Earthwork Project and Utility Project for inclusion in finalizing
Preliminary schedule.

Vista West working on full project plans-will split into 2 projects when basic design is completed.

Earthwork Project 50% Drawings ready for review 8/25/10

Utility Project 50% Drawings ready for review 9/28/10

Fence on West of our site needs new fence to livestock in field-approximately 600 LF. –
See Action Item 1.f

Stockpile of topsoil on Don Roberts property OK with Don.

Vista West needs Terracon report for Greenhouse Project- see action item- 1.e

Patio Design- Jeff to use design on existing plans-(there may be some revisions as design
progresses) See Action Item 1.j

Jason- Discussion of Grant funding of project fence on West of project site- Jason said the Grant
Will NOT cover the cost of the new fence. Doug said to contact Don Roberts and ask him to have
fence installed and AEL will reimburse him for costs incurred for fencing. See Action Item 1.f

Wyoming Business Council Grant does not cover utility costs to site. See Action Item 1.g

Discussion of Grant reports-City should be responsible for Grant Reports to Wyoming Business
Council.

DRC meeting minutes should be out this week.

Ron- There was a lot of discussion about the project schedules. Everyone gave their candid inputs. Ron
will revise the schedules by noon Thursday and distribute.

Discussion of need and schedule for Fire Protection (Water) at jobsite before Building Framing can
begin. See Action Item 1.h

Doug- AEL to finalize project fence needs. See Action item 1.i

Action Items (Description and Person/Entity Responsible):
(number represents meeting number; then lettered sequentially)

1.a- TSP Reviewing applicable Building and Fire Codes as pertains to Greenhouse Project –Special issue
Is Kitchen Range Hood vs Fire Shutter

1.b- TSP will be updating cost estimate due to changes to Storage Room, Office and Spa Room

1.c- TSP will be putting cost estimate together for winter heat & cover based on tight schedule which
indicates cold weather construction.

1.d- TSP to review parking by East cul-de-sac since we have all of 35’ strip-

1.e.- Del to authorize Terracon to give Greenhouse reports to Jeff.

1.f- Ron to call Don Roberts (752-2551) & ask if he will build the livestock fence to West of our site and
we will reimburse him for the cost.
-
1.g- Ron to contact utility companies and advise them of the project and schedules and determine if extra
costs will be incurred by AEL to get utilities to site.

1.h- Ron to contact City Fire Marshall and City Building Department about using existing Fire Hydrant
for Fire protection to allow building framing until new water lines and hrydrants are functional.
1.i- AEL Needs to finalize site fencing needs and plans —–Ron/Doug/Keith

1.j- AEL needs to finalize patio & landscaping Design ——Ron/Doug/Keith

Review of Project Schedule:

The project schedule was discussed at some length with everyone making inputs. Del expressed concern about such a compressed schedule with winter work and heat & cover costs.

Del will estimate added costs for winter work and heat & cover so AEL can evaluate the impact to the budget.

Del is OK with the schedule up through the design/bidding phase. After bidding, the chosen contractor will have some schedule input which will be considered..

Jason feels comfortable with the Earthwork Project according to his schedule input which will be incorporated into the schedule.

Jeff is OK with the schedule according to his inputs today which will be incorporated into the schedule.

Doug requested everyone to try to accelerate all phases of the project.

Next Meeting Date: Wed August 18th Time: 1:00 PM Location: TSP Office

Operations Committee Meeting
8-14-10
Minutes
Present: Kay Wallick, Signe Hill, Ron Callantine, Pat Chilcutt, Carmen Rideout, Peggy Callantine,
Construction/Schedule Update
Ron informed us that the specifications need to be to him no later than mid-September at the latest for each of the items that need to be included in the drawings. Earlier would be better.
IT Follow-Up
The AOD Webinar is September 24 at 1:30. Additional information will be sent out to everyone.
Equipment Follow-Up
Vigil System – We were presented a web slide show broadcast Vigil System. The focus was on the dementia system which is probably what we need. Vigil has a track good record worldwide. Reporting capabilities are also part of this system which can help with quality issues. Peggy will follow up and find out if Wyoming requires pull cords in all bathrooms. Vigil has 24 x 7 telephone support but we will need to follow up on what we need for needs beyond telephone support. Do we plan all rooms for the full range of needs? Peggy will follow up with Melissa on that question. There are systems in Bozeman, MT, where Peggy and Ron will be this week, and Tacoma, WA, where Pat will be next week. The sales person will send information to Pat so that visits can be made. This is a silent system. Pat and Peggy/Ron will follow up with respective facilities. Kay will see if the Vigil system can be included in the FF&E of the Whitney Money.
Medicine Cabinets – Pat talked to someone at the Arizona Green House. She talked about their particular cabinet which they find very satisfactory. Dianna Lloyd at Eddy Village Green in NY told Pat we would have to go through the contractor they used for more information about their cabinets. Pat will contact the contractor. Ron has drawn up a sketch based on the NY dimensions and an earlier discussion about needing different height work surfaces. Medicine cabinets above the sinks and at wheelchair level could be commercial type. The cabinets at wheelchair level would probably be smaller than the cabinets above the sink.
Tub – Pat recommends the Apollo tub. Pat will take a trip to Lovell after she comes back from Washington. Signe will go with her. ARJO will be bringing a tub when they are here to talk about the lift systems. Peggy will change the meeting with the ARJO rep so Pat and others can attend the meeting with ARJO. We can get a comparison price.
Policies and Procedures – In order to make sure all of the required information stays in the policies that have been written as people make changes, we are highlighting the required information. Licensing is the next step. Procedures are worked on as time allows.
Kuehne Foundation Follow-Up
None
Miscellaneous
Beds – There are beds at SMH for Green House. They do not have scales to weigh Elders.
Workroom – Kay reported that the workroom is ready to go but is waiting on passwords and ID’s.
Facebook, Twitter, LinkedIn, etc. – The plan is to get input from everyone about how to set up at Facebook for our Green House Project. More information will be coming from Kay on that subject in the future.
Deb Fleming is coming to town meeting with John, Trudy and Kay to talk about training. How do we influence the CNA training to have the Green House philosophy incorporated?
Next Meeting
The next meeting will be Tuesday, August 31st at 3:00 PM at Callantines. Please let Peggy know if you are unable to attend.

Minutes
Operation Committee Meeting
8-6-10
Present: Sy Thickman, Kay Wallick, Doug Osborne, Signe Hill, Joan Connolly, Jon Connolly, Pat Chilcutt, Ron Callantine, Carmen Rideout, Peggy Callantine
Construction Update
Schedules are being worked on. There have been several meetings this week with architects and engineers. The city has been convinced to allow us to do an earth work package ahead of other construction. Earth work will start in late Sept. and will be completed in Dec. The city will allow a foundation permit for concrete work prior to utilities being complete because we do not need water at the site at that time. The project will be bid in early Dec. for buildings. The construction of the administration building and the first cottage will begin in early Jan., depending on weather. Water should be in by mid Mar. along with framing beginning. The wetland issue has been resolved as part of the earth work package.
The bidding process was discussed. We will have an open bid process and we can prequalify contractors. The bid will be advertised in the Dodge Report that is distributed nationally. We will bid earth work, utilities, and construction, i.e., 3 separate bids.
Therapy Room
The massage table will be mobile to be used in the spa room or Elder’s room. This leaves the spa room more spacious. The therapy room needs to be renamed the Spa Room. Trudy Munsick sent all the specifications to Ron this week.
The dental chair will be portable. The college already has one chair. They recommend we purchase only 1 additional chair.
EMR
Joan talked to Cindy Collins with AOD. They will have a bid to Joan by Monday. They want to give us unique pricing recognizing that there will be more Green House’s in the future. Melissa contacted Cindy via email giving Cindy additional information about us. AOD will make our package efficient for us. AOD has all the components we need. The following dates will be given to Cindy as possible dates for the AOD product demonstration. Fridays best early Sept. 17th 1:30, Sept 24th 1:30, Sept. 18th 9:30. Joan will let us know what date is chosen.
Nyle Morgan will join our committee to help us make decisions re: IT issues.
After touring the hospital with Nyle it is evident that our IT closets have to be big enough for everything. A redesign allows for the needed space. In addition there is room in the administration building for archival storage.
Special equipment
Vigil System – Pat talked to Linda Clark who researched the system initially. Pat talked to Jacquelyn, sales rep for our area, who promised to have a bid to Pat on Monday. This product was strongly recommended by Melissa and other Green Houses. This has a dementia system that seems to fit the Green House philosophy better than traditional system. The nurse wears a receiver and can tell which Elder is calling. The nurse has to go to the Elder’s room to turn off the call system. It is a silent system so there are no bells or alarms going off. Pat has arranged for a web demonstration next Friday at 9 am. Pat will let Kay know the details and Kay will send out information so others can log in to the web conference. Pat offered her home as a site for anyone that would like to join her also. Pat emailed Melissa to ask for contact information of a Green House that has used the Vigil System so that Pat can call and talk to them personally. Melissa responded that Emily will get back to Pat with that information.
Apollo Tub – The bid has been received and does fall within our budget. The only different between the 2 bids is that the more expensive one has a scale. Peggy will follow up to see if the beds donated by SMH have a scale in them.
Medicine Cabinets – Dianna, Director of Nursing, at a NY Green House was contacted by Pat. Dianna and a cabinet maker designed their medication cabinets. Her administrator advised against her sending drawings to us but she did send a sketch. The cabinets are 46”x 24”x 3”. One side of the cabinet is for treatment supplies. The other side is for medications. The cabinets have a drop down desk/workspace. The interior holds 30 days worth of medications. All cabinets have the same lock. They are made of Melamine so are easy to clean. They are just inside of door of each Elder’s room. They couldn’t manage without a cart because some Elders needed applesauce, juice, etc. to take their medication. They purchased a tea cart for this purpose which kept it from looking institutional yet met their needs.
Bathroom cabinet – Donna Taylor, from the Arizona Green House that Signe visited, was on vacation so Pat will contact her this week. We can design our own cabinet for the lower cabinet and purchase standard cabinets for over the sink.
Meeting with Maureen
Sy emailed to Melissa Honig re: admission policies. Sy also talked to Keith Wilson about admissions and the financial implications. Approximately 50% in most skilled nursing facilities are Medicaid because of turnover, etc.
Sy met with Maureen to get started to create policies. He expects the policy to be somewhat vague but initially residents must be 1/3 Medicaid, 1/3 Medicare/1/3 Private Pay. Sy has looked policies on line. They contain statements such as Individuals will be under review before admission, etc. in these policies to allow for flexibility. Sy will meet with Maureen again in early Sept.
SMH Involvement in Green House
Mike McCafferty and the hospital have been very clear from the beginning that we support the Green House project but that it is not in the mission of the hospital. The hospital may be able to provide services to the Green House but it must be mutually beneficial.
Peggy talked to Kirsi Ludwig, Manager of Pharmacy at SMH, regarding providing pharmacy services for the Green House. She will do some checking on things like if the retail license is still active, etc., and will get back with Peggy. Peggy will follow up.
Nyle Morgan already talked to this committee about the possibility of SMH providing IT backup and services for the Green House. As Nyle is more involved in our committee and knows what we will be putting in place he will be able to provide us with a more accurate estimate of costs. The hospital already provides this service to physician offices.
Wyoming Rehab, part of SMH, may be able to provide therapy services but it depends on how busy they are as we get closer to the opening of the Green House and their staffing situation. Peggy will follow up.
Billing since it is different than hospital billing may not be something the hospital wants to take on, but Peggy has not had the opportunity to talk to the CFO at this point. Payroll may be easier, but again, Peggy has not talked to the CFO yet. Peggy will follow up.
Peggy still needs to follow up on the oxygen signs.
Next Telephone Conference with Melissa
Pat and Joan will both be gone the entire week Melissa is available to us. Peggy will follow up with Melissa to see if she is available on Monday, Aug. 30 after 1100 our time.
Other
The $50,000 from the Kuehne Foundation is contingent on a Memorandum of Understanding between the VA and Green House. The VA requires a contract. It is assumed that this contract would be negotiable. Sy is waiting to hear from Jack Tarter who is on the Kuehne Board and also is in charge of the Soldiers and Sailors Home in Buffalo. Debby Hirshman, CEO at the Sheridan VA, has also stated to Sy that she also would try to get in touch with Jack Tarter and get back with Sy. He has not heard from either of them to date. Sy will follow up on this.
Kay is working on the web site with a workroom that will be password protected. Minutes of our meetings as well as other things will be included. Kay will be the contact person to have items included.
Joan has been in touch with Wesly Wells in San Angelo, Texas. He has given an open invitation for us to visit their Green House.
August 12th at 2 PM there will be a meeting to discuss Facebook utilization. NCB is really encouraging use of Facebook. Everyone is invited to attend. Kay will send out additional information on this.

Conference Call with Melissa Honig
7-28-10

Present: Pat Chilcutt, Signe Hill, Joan Connolly, Sy Thickman, Peggy Callantine, Melissa Honig, Emily Duda

Emily was introduced to the group with an explanation of her background. Emily will be very beneficial to us with her intergenerational experience. Peggy will pass that information on to Kay Wallick.

Melissa will be in Lovell in September, probably the week of the 20th. We invited her to Sheridan and offered to pick her up and bring her to Sheridan. She did not say no!

Joan discussed the HER reporting that AOD seems the most logical choice. Melissa has worked with AOD from an administrative perspective. Melissa will call AOD’s rep in California and answer any questions they may have. AOD has offered a discounted fee because we will be the first organization using their product in Wyoming. Melissa will call Cindy at (954) 718-6477 cindyc@aodsoftware.com.

Joan asked about the number of computers in each home. Melissa reported that generally there is a computer in the office that everyone shares. Some use a computer in the kitchen in a private area to document % of meal eaten, ADLs, etc. One place is trying PDA’s. It is important that you do not have your back to the Elders when you are documenting.

Melissa asked how SMH will be involved with the Green House. Suggestions include: Billing, Payroll, IT, Pharmacy. Peggy will following up on these ideas.

Pat discussed the Vigil egress/call system. Jackie is the contact person. Melissa is very impressed with this system. It seems we have most of the information that was sent to Linda. Melissa will send additional information to Pat. Vigil does the floor plan, installs and trains. Linda Clark has the quote. Pat will follow up with Linda on the quote. Ron will need this information for the plan documents.

Pat discussed the Appollo tub which has a reservoir, 99% bacteria control and hold an Elder up to 400 pounds. Melissa stated that unless our hospital specializes in bariatric patients the 400# capacity is probably fine.

Pat has some concerns regarding the medicine cabinets. Melissa reported that some are custom made. Pat has some pictures take by Signe in Arizona. Melissa state that St. John’s in Billings has verbalized some concerns about repetitive motion in turning the key lock type. We will follow up the next time we are in Billings to see if the complaints are universal or isolated. If pills are to be crushed in each room shelves need to be sturdy enough to accommodate the pill crushers – most places use Silent Nights.

Narcotics are kept in double locked boxes in the office. Refrigerated medications are also kept in the refrigerator in the office.

Sy asked about AED’s in the houses. They usually have at least one AED to share. Pat will follow up and find out what our SNFs in Sheridan do related to this. There probably will be patients that intend to be coded.

Sy asked about the Dental Chair/Care – Melissa suggested that if we were going to have Dental Care the Administrative building might be a good place or the patient’s room. We talked about the relationship with the college and the Whitney requirements.

Sy asked about smoking. Smoking has not been a problem except with staff. Since schedules are not ridged at the homes a staff member can not count on a break at a specific time, but they usually manage to help each other get out for a smoke break when they need it.

Peggy asked about O2 signs. We will talk to the state about their intent and how we can meet that intent in an acceptable way to the Elders. This may be more a Joint Commission issues vs. state regulation issue.

Peggy asked about a written admission plan that the state is requiring. Melissa suggested we base our admission plan on our financial feasibility/payer source mix.

Peggy asked about fire drills. Melissa said that Elders are generally not taken outside, but are moved to another fire compartment within the building for the drill.

Melissa offered a follow up call the week of August 23rd,Thursday or Friday. We will put that on the agenda for the Aug 7th meeting and let Melissa know the day that works best for the majority of the members. Sy will be out of town the 7th. Friday will work better for Sy.

Operations committee Meeting
7-17-10
Present: Joan Connolly, Jon Connolly, Signe Hill, Pat Chilcutt, Sy Thickman, Kay Wallick, Ron Callantine, Peggy Callantine, Nyle Morgan, Molly Morgan,
Nyle Morgan is the Chief Information Officer at Memorial Hospital with years of experience setting up information systems of all sizes. Nyle talked to us for about 1 ½ hours about different aspects of information technology we need to consider.
Fiber-Optics – ESSENTIAL
ACT fiber-optics are currently in place to the Rockwell building and down 5th street to the hospital. It is Nyle strong recommendation that we bring fiber-optics off Mydland Road to the GH and run CAT 6 cabling in each building to ensure a good infrastructure for the future needs of the facility. With fiber-optics we can use l.5 (T1 speed) or greater ( to gigabit speed) paying for only what we need and use. If we don’t put in a good infrastructure now, we will have to retrofit it later which will cost more in the long run.
With EMR need redundancy – Outgoing and internally
Nyle is on the board for the State Health Information Exchange that will tie to a National Exchange Network. CMS is requiring some electronic submission of data and it is expected that the amount of data submission will dramatically increase related to quality measures, billing, etc.
Wireless vs. Hardwired – ESSENTIAL
Work station PC’s need to be hardwired. The Administration Bldg PC’s and the Office PC’s can be hardwired. There may be other documentation stations in the GH’s that could be hardwired also. However, there will probably be need for wireless also for mobile devices. Each building needs to be configured for both wireless and hardwiring.
Internet Services – Public and Private – ESSENTIAL
There will need to be a internet service for staff which is behind a firewall for security and a separate public internet service, outside the firewall to protect us from viruses, for elders, families, and visitors to protect health information.
Telephone Service – VOIP RECOMMENDED
We need to look at Voice Over IP for phone systems. The telephones run over computer network so we don’t have to run telephone lines and data lines. Both share 1 line.
SUPPORT FOR IT SYSTEM
Labor will be the biggest cost. Nyle estimates 1-2 people rolling over hardware every 4 years, software maintenance, etc.
There is an ASP model where the system is housed outside of the facility and GH would pay by use vs. support internally.
The hospital is offering a service to some physician offices to be backup for all services for a monthly feel. Nyle estimated $3-4,000 month but he was assuming many more computers than we will actually have so this price is probably not right.
It is essential to have data backup. A storage area network where servers runs off line and data is stored in separate area. This should be automated. This could be housed at SMH vs. a closet at the GH.
Servers $3-7,000 ea
Switches $12,000 ea CISCO
$100,000 +software Estimated
We need to put in place what we need to build on. We don’t want to have to go back and redo it. In the end it’s cheaper.
It was agreed that Fiber-optics, Cat 6 wiring, hard wired work stations, and wireless access, public and private internet services are all essential with VOIP recommended.
Nyle will check to see if SNFs have the ability to get Federal money to help with our EMR financing and give that information to Peggy. Medicaid may be another option to look at. Peggy will contact James Busch.
Special Equipment
Ron as principle contact with the architect will be contacted by anyone with equipment that will effect the design and plans.
Kay and Ron will check with True Colors regarding equipment for cosmetology space and equipment. They will also check at Sugarland Ridge and others regarding pedicures and manicures, etc. that will help define equipment and space needs.
Kay has the specs for the massage table. Kay will email massage information to Ron. Trudy has information regarding the mobile dental hygiene chair. Kay will follow up with Jan Dill thru Trudy regarding the dental hygiene chair. Kay will clarify what “portable” dental hygiene chair really means. Kay requested additional opinions regarding the tub which is a $10,000 step-in type. Pat will get involved in that . Kay will email tub information to Pat and Ron
Do we need ceiling lifts for the tub, beauty chair, massage chair? Peggy will contact Melissa Honig or her assistant regarding the lifts in the therapy room. Kay will email Melissa’s assistant’s contact information Peggy .
Pat will look into the following items:
Built in medicine cabinets – lower (for personal items) and medicine cabinet (for meds/supplies for nurse)
Nurse Call System – on bed/in bathroom/internal communication
Egress/security system
The last 2 may very well end up being part of the Information System so Pat and Joan will look at those together.
Peggy has been asked to talk to the Board about the potential of bringing Melissa or her assistant to Sheridan so that all of us can asking all of our questions vs. the many, many phone calls, emails, etc. to them.
Peggy will send a staffing matrix to Pat.

Culture change

Operations plan