Taking Healthcare by Storm: Industry Insights with Travis J. Davis

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with  Travis J. Davis, MHA, NHA, FACHE, HSE, Executive Director of Long Term Care for the Pennsylvania Department of Military and Veterans Affairs. 

Travis discusses his role overseeing Pennsylvania’s state-run veterans homes, the unique aspects of these facilities, and the lessons learned from the COVID-19 pandemic. He emphasizes the importance of addressing staffing shortages, leveraging technology, and implementing person-centered care to improve the quality of life for residents.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-110725-GK

Transcript

 Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today I am honored to be joined by Travis J. Davis, MHA, NHA, FACHE, HSE. He is the executive director of long-term care for the Pennsylvania Department.

Of military and Veterans Affairs. Travis oversees the governance and operations of six state run veterans homes across the Commonwealth, providing care to more than 1500 veteran residents. I am very excited. . My heart is in long-term care medicine and I love to learn and hear about how these veterans' homes are doing things a little differently than the industry standard.

Travis has a background as a nursing home administrator and senior healthcare leader. He stepped into his current role during one of the most challenging times in recent history, more challenging in the long-term care space. This is the COVID Pandemic, of course. Since joining the Department of Military and Veterans Affairs in 2021, and I'm gonna be saying DMVA as abbreviation, he's led efforts to strengthen oversight, improve communication, and elevate the quality of care in veterans homes.

Under his leadership, several facilities have earned top ratings and national recognition. While resident satisfaction and staff morale have reached new highs, right, providing better care, it's just the pinnacle In this conversation, we'll dive into Travis's journey, the unique role of Pennsylvania's veterans homes, lessons learned from the pandemic, the future of long-term care.

And how technology including AI, is reshaping the way we care for our nation's heroes. Travis, thank you so very much for joining us. Thank you, Dr. Storm. I'm the honor and a, a privilege to be here. That was a really kind and flattering introduction. And I have to say, I, I have a tremendous team here in Pennsylvania with our state veterans homes and without them it's hard to achieve some of the uh, the great things that we're doing in our veterans homes.

So happy to be here. Yeah. Team is important. So you started your career outside the VA system. Eventually became executive director of long-term care for the Pennsylvania Department of Military and Veterans Affairs. Can you share what inspired you to make the transition and what drew you to working with veterans?

Sure. So yeah, I think it goes back to my values and I think they've always aligned really well with the nonprofit and public service work. Especially working with seniors and adults who are living with disabilities. The opportunity to work with veterans really came during 2021 when the nursing home industry was reeling um,  from a devastating impacts that we had during the pandemic.

 I mean, Staff residents. Our families, they were all coping with a lot of grief, loss, and trauma and staff dealing with burnout. I remember I was sitting in the administrator chair in a local nonprofit community nursing home at the time, and I, I was reading the Philadelphia Inquirer and I remember a story was run and it was run through multiple news outlets.

Really highlighting some of the challenges and what they were perceived as failures of one of our state veterans homes in Philadelphia. And it was really deeply moving for me to read the report and it troubled, it was troubling for me to read it. I think it underscored how much the, our system was going through, and it was overwhelmed at the time and how our residents and our caregivers were, constantly being exposed to risk.

How trust was being eroded. But it also, it drove me, to wanna support these amazing caregivers during that time and stand with them, you know, not only to just rebuild confidence in the state veterans home program, but also to help them, help them put together, stronger protections and be more transparent and have more accountability.

Yeah, it was a very challenging time. It got me where I am today, so I think it was very impactful for a lot of people, including you. So Pennsylvania operates six state run veterans homes with around 1500 residents. For listeners unfamiliar with these facilities, can you give us an overview of the services provided and what makes them unique compared to traditional long-term care centers or nursing homes?

Sure. So we have six campuses that are geographically spread out through throughout Pennsylvania.  We have six nursing homes and we have three personal care homes. Those are our two levels of care. But there's several things that make a veteran's home special. veterans homes primarily care for veterans, but they also care for the spouses of a veteran, which is very unique.

We also have a population that's predominantly male. Any one of our homes. If you go in them today, you'd probably see between 80 and 85% male population, which is the exact opposite of what you would see in a community nursing home. but we're also, you know, this population often has unique medical and social needs related to their time and their military service.

I think some things that make us really special is the camaraderie that we have.   We have veterans living amongst other veterans and it builds that sense of community. Belonging.  And just understanding,  there's a lot of history inside these veterans homes and it's really unique.

Also in our state veterans homes, they're, partially funded through the federal va as well as the state. But the VA helps subsidize a lot of our costs to keep our construction projects moving forward. Renovations constantly moving which is really all really important, especially when we're looking to how we're gonna tailor the care to meet these.

Special needs of this population. We have a lot of people with PTSD traumatic brain injuries, amputations and other exposure, related illnesses.  So I think that the VA and state support's critical.  But we also have a lot of fun. So we have a lot of veteran service organizations. We have the Fraternal Order of Police.

We have a lot of first responders. We have. Professional and college sports teams that are always in our buildings helping with our activities program. And to be honest, our activities blow it out of the water. It's something I've never seen before until I came to the state. A lot of it's due to something that we call the resident welfare fund, and that's if anyone provides a donation to one of our veterans homes, it goes into a pool of money that's directed by our residents.

And all of these funds are pretty substantial and they allow us to do. A lot of fun things with our residents, both inside and outside of the facilities. So, any week you come in, you'll see a packed activity schedule. We'll have live music, we'll be going out to games, going to restaurants, going to movies, going to concerts.

It just doesn't stop. It's, all year round. It's what these veterans and residents deserve. And I think it's really important too, just for the social impact.  I've seen it firsthand through my grandmother who was a spouse of a veteran. She was a very social person for her life.

  The last few years living alone in her home. She was getting out less less visitors in the home, especially during COVID. And she came into the veterans' home and she really flourished and I saw that social isolation piece really go away. And,  And it overall, it impacted her overall health.

 She did really well. And I think that to me is one of the things that really makes us special compared to the other community nursing homes. Yeah. Including that social aspect as part of overall health, I think is really essential. And that is certainly what sets these facilities apart.

We talked a little bit about COVID and how devastating impact was on long-term care facilities, including Pennsylvania's veterans homes. What were some of the hardest lessons learned from that period and how have those lessons shaped policies and preparedness emergency preparedness today?

Sure. It's, COVID is something that, we've learned to live with.   It's something like, flu or, I mean, this is something that's just part of our business now day to day. And certainly during the pandemic there was a lot of lessons learned and challenges, and I think staffing was one of the weakest links.

We already were dealing with some shortages at the time of the pre pandemic, but then when the crisis really started to hit and we had staff become sick or quarantined or burned out, I mean, that was really difficult for us. We learned quickly that the adequate numbers, I'll say the numbers that we try to meet every day, those alone weren't enough.

 Staff also needed, cross training. They need flexibility and they needed emotional support. I mean, it was a very scary time for our staff. I think that talking about, socialization and mental health and isolation, I think that had a huge impact on our residents. I mean, There were, we endured long periods of time without visitors.

We had people coming to us, some of them were at the end of life and they were, not seeing their family as much as they would like to see. That took a huge toll on not just the residents, but everyone who's involved with their care. I do think, infection control, I don't think it was strong enough at the time.

We've learned a lot and we've put a lot in place through emergency preparedness. Our homes right now have. Deeper reserves of, PPE and, essential supplies. We now have, dedicated infection control specialists in all of our homes who, dedicate their entire role to training people on this year round, tighter protocols.

 We're doing regular drills and audits all the time in our homes. And having readiness plans in place, not just for COVID, but for any future respiratory outbreaks that, hopefully we don't see. But when we do, I think that, nursing homes now, unfortunately, through the pandemic, we had some hard lessons to learn, but now I think that we're better prepared going into the future.

Yeah I would agree. So staff shortages are a nationwide issue in long-term care. How are you working in Pennsylvania to recruit, reach chain, and support caregivers in veterans' homes? And what innovative strategies have you seen make the biggest difference? Sure. I think that's our biggest challenge and I don't think I'm alone saying it for nursing homes.

Staffing is our number one challenge.   Pennsylvania's. Population is aging. So is the rest of the United States, but the caregiver workforce just is not keeping pace. I've seen the workforce shortages in nursing homes force. Many providers to limit or deny admissions. I've seen them, have to close their facilities altogether, and that's creating access issues for, this vulnerable population and causing backlogs for hospitals when they're looking for discharges.

So right now, we're laser focused on this. We're working on policy, we're working with our legislative, members from across the state on, building pipelines for this industry. We're working on a lot of different type of incentive programs like loan forgiveness affordable housing or caregiver incentives childcare incentives, I should say.

Looking at grants, to give for schools, whose graduates want to come and work in long-term care. There's also a lot of barriers to getting into the profession,   if we can expediate the progression of. An LPN to say an rn or if, we can look at the CNA certification process and look at some of the red tape that's been put around, banning in-house CNA training programs because of, deficient practices in the past for a facility.

Like, those are all things that just don't make sense and that we have the control to make it easier and faster to get people in our industry. Another major thing that we're focused on is culture. We've spent a tremendous amount of time listening to our staff and the. The asks of the staff have certainly changed in my career from, 10, just, about 10 years ago, the things that were important to people during interviews.

I heard a lot about, salary and benefits, and today I'm hearing more about work-life balance and flexibility. So we have to listen and we have to create a culture within our veterans homes where people wanna be. It's a challenge, but it's something that, I don't think ever has an end to.

It's something that we're gonna continue to build upon each and every year. And, ultimately we want to get people into the profession because what we're finding is once we have people in our doors are, our retention rates are really good. So I feel like. The mission of working with veterans and just the gratitude and, and what you take away as a caregiver is really meaningful.

So I think, continuing to open our doors for people to come in and see the work we do is really important. Yeah I would agree. So you may have just answered this next question, but I'll ask it anyway. Sure. So from your perspective, what is the single biggest current threat facing long-term care facilities today?

Whether it's financial, operational, or clinical, it might be staffing, it might just be what you answered. Yeah. Again, I think staffing is the linchpin here. If we cannot recruit and retain. And support, a skilled workforce, then everything falls.   it's a financial issue.

It's quality of care issue. And a lot of facilities, again, are at risk of closing. I sit on a board a few boards with other providers and we hear about, Pennsylvania and other states looking to increase their minimum wage. I think. For the most part, all providers support that. The challenge is the reimbursement needs to follow it.

That's gotta happen, and that's one of my fears right now, is that Medicaid. In the nursing home industry, we have to stay competitive because we've seen our costs, not just on the labor side, but just overall in order to support our operations has really gone up without seeing the reimbursement, keep pace with it.

Yeah I think that's like, that's huge, right? People want to be paid for the work they do. Definitely. So we're gonna shift a little bit and talk about one of my favorite subjects. We know that palliative care and hospice services are especially important in long-term care. How do Pennsylvania's veterans home approach end of life care, and what role does hospice play in supporting both residents and their families?

Sure. And I, I do love this question, Dr. Storm as, as you know, hospice and palliative care is near and dear to my heart. It's, I spent part of my career with a great nonprofit starting up a, hospice service that led to also having inpatient units and a community-based palliative care service.

So. Something that's really, close to me and something that I'm very passionate about, making sure that we're utilizing both hospice and palliative care services appropriately in the nursing home setting. So. I've worked in nursing homes that have their own palliative programs or in-house end the life care programs.

And I've worked with other nursing homes who have a combination of both bringing in hospice providers or, just, relying on the hospice or palliative care teams to come in and care for the residents. And what I would say is I think having a hospice provider in a facility compliments, I don't think it replaces the care that the nursing home provides.

There's so many things that come along with the hospice benefit that I think some of the in-home pro programs cannot do.  One thing I look at is the support for a family. With the hospice benefit, the bereavement support for families up to, I believe it's 13 months after residents passing.

That's a really important benefit, especially for someone who loses the spouse and is now trying to, adjust their lives after, a few months after the person's gone and having someone, check in on them and provide. Bereavement or spiritual care and counseling. I think that's so important, and that's one thing that is lost when we do some of these in-home programs on our own.

So I love seeing the collaboration with really good hospice providers, and we're fortunate to have some really good partnerships across the state in their hospice teams and our palliative teams. They know our staff really well. They're involved in the care plan meetings and, making sure that all that communication's on the same page is really critical.

So, we're looking at ways to constantly improve in that area. We're constantly looking and working with our r nacs and our, medical directors and our pharmacies to make sure that, we're capturing people that we need to have conversations with and talking to families.

And it's something that, is definitely a priority of our nursing and our medical team within all of our homes right now. Yeah. And it, like we, we've talked offline about how important both palliative and hospice is so new technologies, everybody's talking about ai. So I'm gonna talk about ai, I'm gonna ask about AI next, but.

I'm really interested in new technologies. So we know that long-term care is evolving rapidly with new technologies, whether that's remote monitoring, electronic health records that you know are doing novel things. So how are Pennsylvania's veterans home leveraging technology to improve care and quality of life for residents?

Sure. So right now, we're leveraging technology. And we're focused on improving the safety of our staff and our residents.   It's been alarming in the United States just to see how the increase. In attacks against healthcare workers has been happening in, nursing homes and hospitals by patients and visitors.

I think, leveraging technology to create a safer environment for our staff is one of our biggest priorities. Something that we've been working on in the state to implement, to give those caregivers some reassurance that, they're coming into a safe environment, especially in the veterans' homes when, like I said, we're dealing with a, predominantly a male population, a lot of them dealing with, some unique medical needs. That's one thing that we have to get that right, right off the bat, and that's something that we're focused in on. But also, AI is going to introduce a lot of things to our homes where we can make care safer, we can have it more personalized, I think more efficient.

And what I hope it does. Dr. Storm is, it helps our staff focus really on what matters most. And that's, that human compassion, that connection side with our residents. So if we can eliminate some of the work that they're doing behind the screen and allow them and free up their time so they could spend more time with their residents and their families, especially during the end of life process where we want them to be there.

That to us is gonna be where AI can really change things for us. Yeah. And that's where I was gonna go next. And like, what role do you see AI in? Because I think I will just say I think it's, very challenging everybody. I mean, you see, You can see a lot of risks. So you see it in making a caregiver's job.

In the facility easier so they can kind of a burden reduction so they can spend more time with residents. Like do you see the role maybe in any, like, predicting health issues or improving resident engagement? Are they, is it used that way in any of the state run? Yeah, so right now it's not, and I see what's happening in the hospitals.

A lot of the AI and decision making and helping with diagnoses, like all that stuff is definitely, out there, and it's being used by hospital systems. What I see happening for our state veterans homes in the near future is helping us analyze things like vital signs movement patterns of our residents utilizing it to help us predict falls rather than just alert us when a fall happens.

I see it helping us with. Infections and things that, might help us reduce hospitalizations or, stop them before they even happen. Certainly there's a lot of emerging technology out there with sensors and cameras, all things that we're interested in and we're looking at right now.

But anything that, that could help the facility with residents who maybe have behaviors like wandering or certain changes or signs of distress that we could. Leverage AI to help our, clinical team. I think that's gonna be really important for us to stay ahead of, because again this technology is coming out so quickly.

I know that we cross paths a lot at conferences and things like that, and I feel like every time we go out there's a new emerging technology in the AI space and I think once that stuff gets integrated into our electronic medical records, it's, that's when our industry is really gonna start seeing the benefits and where it could, help our residents and our teams.

I, I agree. I was just talking to someone at a conference  day before yesterday about how we're on this, we feel like we're poised for change, and I think AI is gonna provide that change. So it's a, it's an interesting, it's a really interesting and fun place to be, I think in long-term care right now.

So talking about something that maybe we don't like to talk about in the long-term care world, but reputation and many times long-term care facilities receive negative media attention. But your veterans homes have earned top ratings and recognition. I know soldiers and Sellers home is located in Erie, fairly close to me.

It is just everyone who needs a nursing home wants to get into that. Facility because the reputation is so good, everyone knows that the care is just excellent. How do you work to change public perception and highlight the successes happening inside these facilities? Sure. You know that it's a challenge and it's something that I think is made me more and more passionate about our industry and advocating for the work that's done, behind the scenes.

And I think. Changing public perception. I think it really starts with transparency and storytelling. We do a good job of highlighting you know, the quality of care that we're delivering and the programs and the activities through social media. But  really think the impact comes with opening our doors and inviting people in.

So whether that's family, our community leaders, when they get to come in and see firsthand what we're doing, that, that level of care that we provide that's really what opens people's eyes. And I'm a big adv advocate for getting into the schools, whether it be a high school or an undergraduate program or maybe a graduate program or a nursing school, getting in and talking to them and having them come in and spend some time in one of our homes because.

Long-term care isn't the sexiest term and to be honest, and it, a lot of students are thinking about the acute care setting or are thinking about working in other healthcare settings, which are obviously very important as well. But I think that, long-term care. Falls to the bottom of their interest.

But what I've seen time and time again is when we get them in here and they see the work that's being done, but also what makes us unique is that we get to build long-term relationships with our residents and patients. Whereas, you know, a lot of the short-term setting of the hospitals, they're in they're out.

I think that connection with people really makes a difference to a lot of people and that's one way I think that we help, overcome that public perception. By consistently demonstrating what we do with, our compassion, the accountability I, I just think that. These, the winds of our industry happen every single day.

Unfortunately, what we see in the news or read in the newspaper, those are the outliers that unfortunately put a cloud over our industry that, it just isn't really the truth of what's going on. So, being transparent, opening the doors, welcoming people to come in and see, I think that's the best way to approach that challenge.

Yeah I would agree as well. Letting people and letting people see what's really going on. So this is the last question, and it's a big question. So, if you were given the opportunity to design the long-term care system for the entire United States, what would be the first three changes or priorities or maybe just the most,  the first one that you would focus on to improve care for older adults and veterans?

there's a lot of thought that I've put into this.  Having looked at other countries models for how they deliver healthcare and looking at United States I think that we. We have to address the workforce crisis first and foremost, I think, caregivers, nurses are the backbone of our industry.

And without them, and without having the people who are well trained in those positions and support it, everything kind of suffers. Whether that be quality, safety finances, everything is gonna suffer if we don't, take a look at that, and that could mean looking at, legal ways for.

Bringing international people into our workforce. I think it's been done successfully in the past, and that's something that we should be looking at as a piece of how we could, combat and, you know, work towards a, resolution or, just some ease with the workforce issues that we've been facing for years now.

A second area I would look at is. There's gotta be a shift towards more of a person-centered community type setting. I think most adults especially veterans, they want to age and live in a place with dignity in a setting that feels more like home. So I would expand funding to redesign nursing homes so they're in, into smaller kind of neighborhood like style models.

And ensuring that, their care plans are tailored to their goals and preferences, not just solely their medical needs. I think that's really important. The last thing I'll say is, the financial sustainability. I think long-term care has historically been underfunded in many areas.

And we're all struggling to compete for staff right now while maintaining quality. So I, I think that there's gotta be, a future plan for how we're gonna keep up, reimbursement in this country for nursing homes.  Medicaid's obviously been in the news a lot and there's a lot of uncertainty of where that's gonna go.

That's something as our. Population continues to age, these resources are gonna be needed even more than ever in the future. So how can we do all of this? How can we improve our efficiency while maintaining that human touch in a home-like environment? Those are the things I'd love to see, come to fruition in my career.

Yeah, that, I love that you said homelike environment because I think that is so key. And I think that's what the Veterans Affairs homes do so well. Really making people feel at home. So if individuals want to learn more about the state veterans homes, I think you and I talked about a website. Is it the National Association of State Veterans Homes?

They can visit. So the National Association is a group that all state veterans homes belong to throughout the country. So whether you're living in, Pennsylvania or West Virginia, you can go there and get resources to all the state veterans homes throughout the country. For Pennsylvania you can go to our our website.

It's easy to Google and go to Department of Military and Veterans Affairs. On there you'll see our different facilities, our levels of care, and also you'll see an application for admission to one of our homes. I always encourage families to apply to our homes even if they're not quite ready.   We do have wait lists at some of our homes, and you know that's not something people expect when they need placement. Most times it's coming after a hospitalization or they've had a fall or a stroke and they're looking to get into a home right away. And unfortunately we may not have a bed for them.

So I always encourage families, if you have a veteran or a spouse who's struggling at home or even thinking about a state veteran's home. To put an application in. They get onto a wait list and, when their name comes up and we give them a call, if they're not ready, then we just put them at the bottom of the wait list and they stay on there.

But it gets a lot of the paperwork and some of the process and the ball rolling before the family, you know, needs to formally. Make that request and look for a bed placement. So it's,  there are hard times for families to navigate through. So if we can, you know, ease the burden by giving them information, getting them out to one of our homes for an event or a tour, that's what we'd like to do.

Yeah. Get on the list early. Travis Davis, thank you so very much for joining us today. I really enjoyed the conversation. Thank you, Dr. Storm. It was a pleasure and I appreciate you having me on.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.