KING — Gov. Scott Walker is proposing another big boost in direct-care staff at the state's largest nursing home for military veterans, but first the home must raise millions of dollars to pay for the workers by once again ramping up occupancy.
The last big increase in residents at the 721-bed Veterans Home at King in 2011 led to tens of thousands of hours of overtime last year, pushing some workers to the breaking point. The union that represents most direct-care employees has argued that quality of care is jeopardized when hiring falls behind new admissions, and King administrators acknowledged some of the concerns in their 2013-15 budget request.
While federal ratings suggest the facility is better staffed than comparable homes, inspections conducted by the state Department of Health Services have cited more quality-of-care problems in the last two years. Officials at the state Department of Veterans Affairs, which operates the home, claim the number of citations is meaningless.
"It happens no matter how good you are," Randy Nitschke, top administrator for state veterans homes, said of citations. "King is a gem and a leader."
But other experts say federal performance measures that list King a little above average amount to faint praise because the ratings are drawn from comparisons to other nursing homes in a struggling long-term care industry that has long been underfunded.
Poor funding from government health programs erodes the ability of homes to feed, bathe and care for residents with varied health problems, while pushing nurses and aides toward higher pay in hospitals, said Barbara Bowers, a UW-Madison School of Nursing associate dean for research.
"I've never been in a nursing home that's been sufficiently staffed, and I think it's getting worse," Bowers said.
Management shortcomings at King have been highlighted by the state Legislative Audit Bureau for decades. In 1993 and 2004 the bureau criticized excessive overtime and poor labor relations, and in 2011 auditors said weak oversight, infighting and management turnover contributed to an array of financial problems at King and a smaller home at Union Grove.
Seeking more funding
King is made up of four nursing homes that have housed between about 650 to 700 residents over the last few years. Civil War veterans in 1887 established a home about 100 miles north of Madison in Waupaca County. It was later turned over to the state.
In 2001, the state Department of Veterans Affairs opened Union Grove, about 85 miles southeast of Madison. They had a combined $90.6 million budget for 2011-12. Recently, the department opened a 72-bed facility in Chippewa Falls. Unlike King and Union Grove, it is run by a private contractor.
King is pushing its occupancy closer to its 721-bed capacity to pay for more staff there, subsidize Chippewa Falls for a few years and lay the financial foundations for replacing one of King's four residence halls in the near future, said John Scocos, state veterans affairs secretary.
Even an increase of 10 or more residents would bring in substantial new state and federal dollars, but officials wouldn't be specific about revenue projections. Walker's proposal to add 83 new staff to King would cost $9 million.
Scocos eventually wants to replace King's other three halls and build new homes in Madison, La Crosse, Kenosha, Milwaukee and Green Bay. The veteran population is shrinking, but many returning from Iraq and Afghanistan may need skilled nursing care earlier in their lives, Scocos said.
"We have to have a vision for King and the entire state for 25 years for now," Scocos said.
Staffing lagged behind residents
Before May 2011, occupancy at the home declined for years, as turnover churned through top management. Scocos blamed the Board of Veterans Affairs for overstudying expansion proposals.
In 2011, Walker and the Republican state Legislature stripped the board of its authority and Walker re-hired Scocos, who had been fired in 2009 by the board in part because of disputes over the homes.
King sped up admissions with strong marketing and quicker reviews of applicants' medical needs, which are assessed to ensure the home can properly care for them, Nitschke said. Recently, the department has requested permission to begin admitting veterans from other states, while giving Wisconsin residents higher priority, Scocos said.
In May, the department persuaded the Legislature to authorize increasing direct-care staff to 428.5 from 389, although hiring didn't increase actual staff levels until late summer. Many new hires didn't stay long. Other staff members also departed, but King ended up with about 30 additional workers by mid-January.
Overtime shifts are less frequent now, but staffing increases lagged behind residency increases for a full year — in part because managers at the home were previously too choosy when hiring, said Department of Veterans Affairs Deputy Secretary Michael Trepanier.
"We said `Stop the nitpicking,'" Trepanier said. "My God, if they don't work out, let them go. That's what probation is for."
King total staffing sometimes exceeds authorized strength because some positions are exempt from the official count, Trepanier said.
New workers still learning
Walker's proposal to add staff would bring King to 511.5 workers, a 31 percent increase since April.
Wisconsin State Employee Union representatives said King won't able to fill the jobs with qualified personnel, especially if there's another avalanche of grueling overtime shifts.
But Nitschke said overtime won't be such an issue in the next growth spurt because King has streamlined hiring, increased pay for some nurses, and the home now hires on contingency, pending background checks.
One King resident, Ruth Gravelle, said she didn't see care at the home suffer last summer, but a lot of good employees quit.
"I could see how it was very hard for them to work those very long hours," said Gravelle, who moved to King in 2009 with her Marines veteran husband, Robert, who died two years ago. "I don't know how they did it. We have some new people now. They're still learning."
King's employee retention rates have been much better than average in Wisconsin, according to state Department of Health Services statistics.
WSEU representative Troy Bauch said recruiting and retention were hurt over the last two years as Walker and the Legislature eliminated most public sector union rights and made workers pay more for benefits.
Trepanier said the absence of union contracts has helped in retaining newer workers because management has removed some seniority rights of long-term workers in choosing work schedules and vacations.
$21 million from King
From 2004 to 2009, $21 million was taken from King operations by the state Department of Veterans Affairs to subsidize the Union Grove veterans facility, where rates had been set too low, the state Legislative Audit Bureau found in 2010. That money could have been used to raise staffing levels, Bauch said.
"They never want to staff adequately," said Dean Johnson, who made $38,000 including overtime last year, his 27th as a certified nursing assistant providing direct care at King. "I keep a smile on my face all day, but it's hard when you are working an extra four hours or extra eight hours every three days."
Johnson, 51, said he loves the daily challenge of getting to know the needs and quirks of residents — including crusty ones who curse and snap at workers — but he said that after weeks of long hours last summer he too often saw workers crying or short tempered.
"You don't want to act differently, but you're tired," Johnson said. "I don't think our veterans deserve that."
Johnson and other union members said hiring didn't pick up until they called legislators. Trepanier insisted that most improvements were planned before, not because of, union prodding.
"We're frustrated with people complaining about King and not wanting it to succeed," Trepanier said. He said the union damaged King's ability to bring in more residents with news releases and news conferences for media near King.