Overtime hours increased by more than 76.9 percent and dozens of additional nursing positions have gone unfilled as the Wisconsin Veterans Home at King struggles with ongoing staff shortages, according to an audit on staffing and quality of care at the home released Friday.
According to the audit, conducted over 11 months by the state's nonpartisan Legislative Audit Bureau, King has been unable to keep nursing positions filled, despite being authorized to hire more than 80 additional nurses in 2013.
As of June 2016, 46.8 full-time nursing positions, or 9.3 percent of positions, were vacant. After the creation of more nursing positions, King used even more overtime, increasing by 76.9 percent, from 36,800 hours in fiscal year 2013-14 to 65,100 hours in 2015-16.
Despite persistent staffing shortages and mandatory overtime, auditors found that the home's federal and state ratings remain high. It also found that over three fiscal years, from 2011-12 and 2015-16, staff-to-resident ratios, as reported by the facility, for each shift at King generally improved and was higher than what the federal government requires.
Auditors also found, through an anonymous survey of King staff members, that while a majority employees thought care at King was good and had either stayed the same or improved over the last two years, 86.1 percent of respondents indicated that they “disagree” or “strongly disagree” that King has sufficient member care staff to handle the workload.
The electronic survey was sent to all 956 employees at King in November 2016. It was completed at least partially by 449 employees, according to the audit.
According to the survey, 39 employees responded that they had witnessed member abuse, neglect, or misappropriation of member property by King employees in the past 12 months, including 13 who responded they had witnessed more than five occurrences.
Nearly all survey respondents indicated they know how and to whom to report member abuse or neglect, but only 60.5 percent of respondents who witnessed an occurrence indicated they “always” reported it, citing fear of retaliation, according to the audit. But more than 80 percent of those who have reported abuse said that it is always addressed in a timely manner and preventative measures are put in place. About 75 percent of respondents indicated that the overall morale of employees at King was “poor” or “very poor.”
In a letter of response to the audit, Wisconsin Department of Veterans Affairs Sec. Dan Zimmerman said the review confirms that King is performing well and delivering high quality care in the midst of a dire national nursing shortage.
"I am pleased to see that your staff’s outside review confirmed much of what I have found in my seven months as secretary — member care at King far exceeds the norm. King staff are truly providing a great service to our most vulnerable Veteran population," he wrote. "The department has already taken steps consistent with many of the recommendations in the report and will continue to make improvements."
Zimmerman said he has already addressed many employee concerns about how shifts are assigned and has made staffing shortages at the home a priority, working to fill positions by implementing new recruiting and retention programs. In July, he reduced the number of beds at King, from 721 to 662, citing staff shortages and a move to consolidate care in some parts of the King campus.
He also noted that he has an office at King and an "open-door policy" to meet one-on-one with staff, and has spent numerous hours listening to employee concerns.
"Your report aptly captures the largest personnel-related challenge facing King — an industry-wide shortage of nursing staff that has caused overtime hours worked to increase significantly over the past few years. This has placed an unsustainable burden on the employees as well as the department budget. Thank you for mentioning the numerous things we have done recently and over time to combat this crisis, such as protecting new hires from mandatory overtime, increasing the number of weekends off for certified nursing assistants, hiring a nurse recruiter, and protecting days surrounding vacation from extra hours worked, to name a few. It is my focus to eliminate all forced overtime and reduce all voluntary overtime to acceptable, affordable levels as quickly and efficiently as possible," Zimmerman wrote.
Auditors also found that from 2012 through 2016, the state Department of Health Services, which surveys the home on behalf of the federal government issued, on average, fewer citations to King for violations of federal nursing home regulations than it issued to other skilled nursing facilities in Wisconsin. Of the 184 citations DHS issued to King, one was in the highest severity category, for which it was assessed a civil penalty of $76,900 in June 2016.
Members of the state's legislative audit committee, which initiated the audit last year, acknowledge the audit's positive review of the King home's ratings, but said there is still more work to do to address staffing shortages.
“I am encouraged that the audit found, generally, the Veterans Home at King is running well, however I think the findings in the audit raise an important issue about the healthcare workforce shortage in Wisconsin," said Sen. Robert Cowles, R-Green Bay, co-chair of the Legislative Audit Committee. "It is my hope that future work regarding this audit will contribute valuable information about the long-term health needs of our veterans and necessary staffing levels to provide them quality healthcare.”
Rep. Samantha Kerkman, R-Salem Lakes, who also chairs the audit committee said she appreciated the quality of care King currently provides but acknowledged there is room for improvement.
"There is more work to be done with regards to staffing issues, including overtime and morale. Workforce issues are challenging throughout the long-term care sector and I look forward to listening to DVA’s plans to address these issues, as well as receiving their subsequent follow-up report in a few months," she said.
Rep. Melissa Sargent, D-Madison, the ranking Democrat on the audit committee, said continued legislative oversight of how WDVA operates the home is needed.
“While I’m cautiously optimistic about today’s performance audit results, there’s still plenty of work for us to do in the Legislature to ensure our veterans are receiving care with the dignity and respect they deserve--there are still unanswered questions about King’s finances, why it continues to see under-staffing and turnover, why it’s generating tens of millions in revenue, and whether it’s using the revenue it generates to put money back into services and programs to actually help our veterans," she said in a statement Friday.
She also noted that, according to the audit, King is also generating $56 million in excess revenue, while still facing serious staffing shortfalls with 46 vacant full-time positions.
The committee recommends WDVA report to it in January with an update on its progress and plans for addressing staffing shortages.
The audit follows an investigation by the Cap Times last August with interviews from dozens of staff and residents at the home speaking about a culture of retaliation, persistent staff shortages and compromised care for vulnerable veterans there, as the state increasingly transferred money away from the home to fund other programs. The first part of the audit was released in May and focused on the home's finances. It found that $55 million had been transferred away from the home as it delayed facilities improvements, including failing to replace soiled carpeting for more than seven years. That audit reviewed financial information at King from 2003-04 through 2015-16.