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Things get worse at vets homes

By Heather Smith, MacIver Institute

Wisconsin Spotlight | Nov. 7, 2022

MADISON — Last week we reported on mismanagement at the Wisconsin Department of Veterans Affairs(DVA) throughout the Evers administration. As we review more documents, we are learning more about the depth and breadth of the crisis in the department.

Here are five more take-aways from public records we reviewed:

  • Late last year, DVA estimated that if nothing changes in the administration of the Wisconsin Veterans Homes – e.g. the censuses stay low, the labor shortages continue, the expenditures continue – the homes will be insolvent by fiscal year 2027 in spite of millions of pandemic aid dollars flowing in to DVA.
  • The census at King and Union Grove are about half their capacity and well below the level required to sustain operations. Yet even with contract staff, forced overtime is still required of staff.
  • Purchasing rules have been waived for the department, allowing them to avoid a bidding process, and continue paying price-gouging rates for staffing contracts.
  • A toxic workplace is cited by staff and family alike as a factor in much of the turnover and continued staffing problems.
  • Secretary Kolar has ignored repeated concerns voiced from leadership in the homes about the management of her appointee, Veterans Homes Administrator Diane Lynch, contributing to high staff turnover.

And 1 takeaway about DVAs handling of open records requests:

  • The department applies different standards of redaction to the same responsive documents, apparently based on who has made the public records request.

Over-reliance on and overpaying contract staff

In the records we viewed, the department consistently responds to press inquiries by saying they use temp agency staff as a “short term” resource to maintain adequate staff levels.

This is not an accurate characterization of DVAs use of temp agency staff.

It is not unusual for public and private health care facilities to occasionally use contract staff to fill in staffing gaps on what are generally short-term basis situations. In private facilities, the use of temporary agency staff must be minimized because it’s not cost-effective long-term.

In state agencies, it may be used slightly more often than in the private sector because government agencies have much less flexibility working within the civil service system. The lag time between application and hiring in government can be unmanageable when trying to address sudden, critical needs.

However, none of that would explain the constant use of temporary agency contract staff at Union Grove, or why a plan was never developed to stabilize facility staffing and by doing so, put an end to the excessive expenditures.

It appears that during the Evers administration, the only staffing plan at the Veterans Homes was constant contracting and contract extensions for high-cost temp staff.

Lynch herself described her staffing efforts as being in “endless procurement jail.” How much they’ve spent on contract staffing is hard to tell based on the records we have reviewed – and it’s not even clear that DVA leadership is effectively tracking their expenditures.

A lengthy email exchange earlier this year between multiple DVA staff including a purchasing manager and the homes’ administrator shows confusion over invoicing intervals, the cost of the contracts per week, and when the purchase order limit would be reached for contract staff.

DVA is currently recruiting for Certified Nursing Assistants (CNAs) at an hourly rate of $18.82, plus a $5 per hour temporary add on through June 17, 2023 (just before the end of the fiscal year), and a $2,000 sign-on bonus. The bonus is paid half in the first paycheck and half when the employee reaches permanent status.

As recently as this summer, records show the department was still paying a staffing agency $90 per hour for CNAs at Union Grove.

End-running procurement rules

On at least one occasion, DVA got the Department of Administration’s (DOA) procurement section to end-run the normal bid threshold, which prevents agencies from contracting for services over $50,000 without going to competitive bid, by giving DVA a special “waiver.”  DOA approved this mile-wide loophole based on the argument that staffing is required by law.

It’s unclear from these records exactly how many agencies DVA contracted with, or that the departments of Health Services (DHS) or Corrections contracted with where DVA piggy-backed onto the existing contracts, but there appear to have been more than a dozen.

What is clear is that the DVA used many contractors, perhaps in another strategy to avoid going to bid, and that the cost was no object. It looks like the cost was never even a consideration. The most expensive vendor we saw in these records was NuWest, which DVA used, and extended contracts with for multiple staff at price-gouging rates.

Management failures

With approval and support of the secretary’s office, Diane Lynch, the Veterans Homes administrator appointed by Kolar, requested extension after extension of temp staff contracts, ran up against procurement limit rules, and was seemingly unable to assess or address staffing needs and stabilize spending.

Meanwhile, department employees who volunteered for overtime had their shifts taken away and given to the more expensive contract staff, while others were moved around between shifts so that they never had a consistent window during which to sleep.

Others who worked 60+ hour weeks were penalized for being 5-10 minutes late for work; others, in spite of picking up many overtime hours, were scheduled on the one day they could not work.

Staff and families at Union Grove have written Kolar and Lynch for years now, begging for a solution to the excessive use of forced overtime that landed at least one aide in an ambulance, another in a ditch and caused many resignations.

But while overseeing staffing levels that resulted in forced 16-hour back-to-back shifts for staff who do a great deal of physical work, Lynch emailed Kolar in June of 2021 saying she was being asked to do more than her normal job, that her days spent at Union Grove might last 12 hours (including commute) and that she was fatigued and stressed.  Lynch asked – and was granted – permission to dial back her work hours on-site in the struggling home which was desperately in need of management and leadership.

The following month, Lynch sent staff, already being forced to work back-to-back overtime shifts, a memo stating, “The only time you should be sitting is when all your work is done.”

In May 2022, the nursing staff said the facility was down to 13 full-time equivalent nurses when 24 were needed.

And May 2022 is also when, in approving yet another contract extension for $90/hour CNAs, Deputy Secretary James Bond thought to ask Lynch for a staffing plan to deal with shortages. It’s unclear whether he had finally thought of it, or whether it came out of a measure of irritation that the money for the staffing extension would reduce the pandemic funds available for the building demolition plan he favored.

Read more at the MacIver Institute.

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