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Wisconsin Veterans Homes

Legislative Audit Bureau

March 2011

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Areas of Review

Admissions policies and resident services

Revenues and expenditures

Staffing levels and compliance with state and federal regulations for nursing staff

Administration of the Aid to Indigent Veterans program

Purchasing procedures

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Facilities Operated by DVA

The home at King opened in 1887.

The home at Union Grove opened in 2001 to provide assisted living care, and it expanded in 2006 to include skilled nursing care.

A new 72-bed nursing facility is scheduled to open in Chippewa Falls in November 2012.

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Occupancy Trends

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Veterans Home Funding Sources

State and federal Medical Assistance payments Payments by residents at private pay rates Federal per diem payments for all residents who

are veterans Federal Medicare payments at Union Grove

only Federal funding for veterans with service-

connected disabilities

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Operating Expenditures Salaries and fringe benefits accounted for

$65.7 million (73 percent) of FY 2008-09 expenditures.

Expenditures increased from $54.6 million in FY 2004-05 to $89.7 million in FY 2008‑09.

Expenditures have exceeded revenues in four of the past five fiscal years.

A one-time $20.1 million Medical Assistance reimbursement rate adjustment made in FY 2005-06 has helped the homes remain solvent.

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Compliance with Federal and State Nursing Requirements

Nursing positions account for more than one-half of all permanent positions.

The homes met or exceeded federal and state requirements for the provision of nursing care.

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Expenditures for AdditionalNursing Time

FY 2008-09

Extra Time Overtime Contract Staff Total

King

Nursing Assistants $ 748,000 $1,046,500 $ 46,100 $1,840,600

Licensed Practical Nurses

199,300 152,200 66,600 418,100

Nurse Clinicians 143,000 163,400 46,500 352,900

Subtotal 1,090,300 1,362,100 159,200 2,611,600

Union Grove

Nursing Assistants 263,600 437,200 0 700,800

Licensed Practical Nurses

41,800 20,600 80,500 142,900

Nurse Clinicians 105,600 117,000 17,100 239,700

Subtotal 411,000 574,800 97,600 1,083,400

Total $1,501,300 $1,936,900 $256,800 $3,695,000

Hours Worked 94,200 69,200 8,300 171,700

FTE Positions Based on Hours Worked 45.1 33.1 4.0 82.2

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Overtime and Position Cost Comparison for Nursing Staff

FY 2008-09

Overtime Cost New Staff Cost Difference

King

Nursing Assistants $1,046,500 $ 979,900 $ 66,600

Licensed Practical Nurses 152,200 119,500 32,700

Nurse Clinicians 163,400 149,900 13,500

Total $1,362,100 $1,249,300 $112,800

Union Grove

Nursing Assistants $437,200 $471,500 $(34,300)

Licensed Practical Nurses 20,600 21,500 (900)

Nurse Clinicians 117,000 111,200 5,800

Total $574,800 $604,200 $(29,400)

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Full-time Nursing Staff Retention Rates

Calendar Year 2009

Nursing Assistants Licensed

Practical Nurses Nurse Clinicians

Full-time Part-time Full-time Part-time Full-time Part-time

King 95.0% 63.0% 94.0% 77.0% 93.0% 100.0% Waupaca County Average 85.0 58.0 91.0 73.0 85.0 76.0

Union Grove 92.0 53.0 86.0 56.0 88.0 75.0 Racine County Average 81.0 53.0 76.0 66.0 72.0 63.0

Statewide Average 79.0 63.0 87.0 71.0 76.0 67.0

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Stipend Programs for Nurses

To help recruit and retain nursing staff, King established two stipend programs.

57 nursing students participated from FY 2004-05 through FY 2008-09.

Expenditures totaled approximately $300,000, excluding participant wages.

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Inspections of Veterans Homes The homes are subject to annual, unannounced

inspections. From 2005 through 2009, the number of citations

the homes received was comparable to the statewide average.

Noncompliance with life safety codes was the most common type of citation.

King was issued one citation for substandard quality of care.

The homes responded to the citations they received.

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Aid to Indigent Veterans Program

The program provides financial assistance to help fund the cost of assisted living care at Union Grove.

The program was initially funded with segregated revenue from the Veterans Trust Fund.

GPR was added in the 2007-09 biennium, and Trust Fund revenue was replaced by program revenue from the homes’ operating appropriation.

The budget grew from $208,700 in FY 2005-06 to $406,700 in FY 2010-11.

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Concerns with the Aid to Indigent Veterans Program

The program was created in June 2005, but formal policies were not developed until May 2008.

In four cases, participants’ assets appeared to have exceeded the $2,000 eligibility limit.

One participant reported $386,000 in an irrevocable trust that was later found to be revocable.

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Purchasing and Contracting

In FY 2008-09, the homes purchased $17.0 million in goods and services.

We found violations of purchasing requirements for 26 of 79 purchases we reviewed.

There were four types of violations:– Split purchasing

– Misapplication of bidding procedures

– Inadequate bid solicitation

– Failure to rebid contracts

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Oversight and Accountability Ambiguous policies and inadequate oversight have led to

significant financial and program management concerns. King used $50,000 appropriated for nursing education as

unrestricted donations to Fox Valley Technical College. Numerous administrative changes have raised concerns

about stability and continuity of agency leadership. Personnel problems related to the veterans homes are

long-standing. Since at least 2006, DVA has planned to develop a

comprehensive long-term financial plan for the homes but has not done so.

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Audit Recommendations We include several recommendations for

DVA, including reporting to the Joint Legislative Audit Committee by July 1 on the specific steps it has taken to respond to our recommendations.

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Wisconsin Veterans Homes

Legislative Audit Bureau

March 2011