Wednesday, August 31, 2016

WisGOP budget tricks lead to neglect at Vets Home

In the category of “you knew this was coming,” is this week’s bombshell story in the Cap Times from Katelyn Ferral, who exposed widespread neglect at the state’s Wisconsin Veterans Home at King. This story comes after several years of concerns over mistreatment of the elderly and disabled veterans at the facility, and also seems to be related to Walker/WisGOP budget moves to fill budget holes instead of invest in services at King.
…Pictures provided to the Cap Times by an employee who did not want to be named for fear of retribution show mold on a wall and a large red stain on the floor of a tub room where veterans are bathed once a week. Employees said the red stain was fixed and the mold was painted over, but remain concerned about the conditions of other tub rooms at King. Carpeting in one late-stage dementia unit is yet to be replaced after being soaked with urine, according to King employees who requested anonymity for fear of retaliation.

A 2013 photo of a tub room where veterans are bathed at the Wisconsin Veterans Home at King showed a large red stain on the floor, which employees said can alarm residents with dementia and/or post-traumatic stress disorder. Employees said the stain has been removed, but other tub rooms at King are in poor condition.

Veterans are packed into small rooms reminiscent of college dorms. Medical equipment, including the nurse paging system, is outdated and some functions minimally, former and current employees say. Beds are antiquated, some welded together. In one federal inspection report from earlier this year, inspectors found King did not have a control program for certain infections, a lapse that had the potential to affect 195 residents. The same report also found that residents were washed with dirty washcloths placed in the drain of a soiled sink….

…Several former King employees who observed admission practices said the state keeps the homes as full as possible, alleging exceedingly sick veterans are accepted regardless of its capacity to care for them. More heads in King’s 721 beds means more money flows to the state from Medicaid, Medicare and the federal Department of Veterans Affairs.

State officials have used King’s money to subsidize its other veterans homes and have transferred more than $20 million in total since 2007 back to Madison to pay for other departmental expenses and salaries. The Department of Veterans Affairs plans to transfer another $18.6 million from King over the next two fiscal years, according to the Legislative Fiscal Bureau. This year, WDVA transferred $12 million out of the fund for the homes.
Now let’s go back to the July memo from Veterans Affairs Secretary John Scocos that revealed these transfers in the first place, and how they were keeping the Veterans Trust Fund afloat. In particular, let’s focus on this paragraph, which describes how the Vets Fund was able to be saved from “insolvency.”
The condition report illustrates a transfer from the Homes appropriations of $12 million to alleviate any negative balances. This transfer is pursuant to s. 45.57 (1) of Wis. Stats., which permits the department to transfer all or part of the unencumbered balance of any homes appropriations to the VTF. The extraordinary turnaround and success of the homes, due to a commitment to efficiencies, cost savings, maintaining census levels and optimizing federal funds has made the DVFA self-sufficient for the foreseeable future.

Well, I guess the Cap Times article tells us what Secretary Scocos meant by “efficiencies”, “cost savings” and “”maintaining census levels.” Cutting corners on staff and supplies, and overcrowding the King facility in order to grab as much federal money as possible. I guess we need to decide if that’s OK (I don’t find it OK).

Things look bad enough that elected officials from all sides of the aisle are now asking for an audit to try to figure out what's going on at King, including both chairs of the Legislature's Joint Audit Committee today. But the Cap Times article also notes that the King Homes have received 5-star ratings from the Center for Medicare and Medicaid Services (you can click on the rating here).

So let’s look at the CMS’s criteria and see how they arrive at their ratings.
1. Health inspections rating:
We base health inspection ratings on the 3 most recent comprehensive (annual) inspections, and inspections due to complaints in the last 3 years. We place more emphasis on recent inspections.

2. Quality measures (QM) rating:
We combine the values on 16 QMs (a subset of the 24 QMs listed on Nursing Home Compare) to create the QM rating. QMs are derived from clinical data reported by the nursing home.

3.Staffing rating:
We base the staffing rating on 2 measures: 1) Registered Nurse (RN) hours per resident per day; and 2) total staffing hours per resident per day. Total staffing includes: RNs; Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs); and Certified Nurse Aids (CNAs). Staffing data are submitted by the facility and are adjusted for the needs of the nursing home residents.
Which makes me wonder what’s going on here. And when was the last of these comprehensive inspections of the facility?Is the quality and staffing data that the King Homes are reporting to CMS actually what the real quality and staffing figures are? (the Cap Times article is more than a little skeptical of this being the case) Something clearly doesn’t add up between what the Cap Times reported and what the CMS has.

Gov Walker was asked about the article and veterans’ services at his latest photo op in Milwaukee yesterday, and expressed surprise at the allegations, given the 5-star CMS ratings. But then Walker followed up with a pathetic whine job about his decision to transfer funds out of the homes.
"When Democrats and Gov. (Jim) Doyle were in charge, they raided money out of the state transportation fund, spending on things unrelated to transportation," Walker said. "Every penny that's in veterans affairs department is either spent on the homes or veterans programs.".
That comparison is bullshit. Here’s why.

When Jim Doyle shifted money from Transportation to other areas of the budget (mostly K-12 education), it was because the money wasn’t needed in Transportation at the time and the excess money allowed other services to be stabilized. This is NOT what was done in the Veterans Trust Fund, where there were clearly needs at the Veterans Homes, but instead of paying for them, Walker and WisGOP chose to fill in the budget holes with that extra money.

PS- Hey Scotty, is using other funds to fill in budget holes something you now find to be OK, or is it always wrong? It’s gotta be one or the other, kiddo. Either way, I suggest you PUT THAT TALKING POINT DOWN.

UPDATE- Looks like there's further news this afternoon on this story, as Katelyn Ferral has a new story out saying that lead has been found in the tap water at the King Homes, leading to this picture from King on Monday.

Today's update and the increased calls for an audit shows that these questions over the conditions at King and other state veterans' homes are not going away. Especially because many of the concerns stem directly from decisions made by the Walker Administration and WisGOP to reallocate the money collected for the Homes to fill in a multi-million dollar deficit instead of paying for needed services and actually asking the (gasp!) taxpayer to help out these men and women who have served the nation. It’s yet another fiscal problem that has never been dealt with over the 5 ½ years of the Age of Fitzwalkerstan, and this is even worse since it involves not helping such an honorable and vulnerable group. In typical right-wing fashion, the WisGOPs were just hoping they could get away with the neglect for as long as they could, until it blew up spectacularly, and now we will likely have to pay up even more as a result.

Tired of this routine, yet?


  1. A sensitive subject for WisGOP--but all the TV coverage mentions is that Walker's office will have DHS Quality Assurance do their own investigation (

    Dems want a federal probe by the USVA and a LAB audit, as does Luther Olsen (King is in his district), but Cowles is now hedging on the LAB, citing its possibly limited resources (

    Just say no to DHS handling this.

  2. About 25 years ago, I worked as a CNA in a long-term residential care facility. In my case, serious and profound mental impairments often coexisting with serious psychiatric issues. My area was considered the most intense for behavioral issues - locked area, no access in or out without a key. Lots of physical restraints. Lots of medication. No wheelchairs - all our residents were exceptionally ambulatory.

    We had a staff of four to work with 16 residents on the PM shift. We were able to get all of our men a shower or a bath every day unless there was a medical order stating otherwise. It's not difficult work, but it is hard work. Spend time with people. Read, go for walks, laugh, play music, dish up a meal, snacks, help the LPN dispense medications, keep the place clean, keep our residents properly dressed, help them attend to basic hygiene, keep everybody safe.

    Our staff was very experienced by the standards of CNAs. We all had at least a couple years with that particular group of people. We knew their likes and dislikes. Knew their medical situations, health and psych plans. We knew where everything was that we needed. We knew how to get help when we needed it. We spent enough time with our people that we knew when things weren't right. We could legitimately help the medical staff and social workers. We met and came to know their families.

    We often knew when somebody was going towards a seizure - could feel a serious behavioral episode rising. When things went badly in other areas, we could assist. We went to the ER with our people more than once. Helped see them through serious illnesses and injuries. In more than one case, I helped care for them when they died.

    I say all this only to establish my bona fides. I say it so that others will know that I have some background when I say the rest.

    The staffing levels listed in the Capitol Times report are not adequate - not for a population with significant medical needs and using a number of wheelchairs. If the food sucks, if you don't have the requisite personnel to get people a bath or a shower at least every other day, if you don't have the personnel to get people to a toilet or very promptly cleaned up after they suffer a lapse, if you're ordering overtime by more than a shift or two in a two week period just to maintain minimum staffing (that's the only reason you order OT), if you're using temporary people from an agency YOU DO NOT HAVE A SURPLUS.

    People working too many hours cannot do this job properly.
    It takes experience to do this job well. Most CNAs don't last a year.
    Temporary personnel unfamiliar with people, procedures and care plans can only provide baseline care.

    In this case, I don't even care to make partisan points. Stop trying to fix the blame and fix the problem. Enough. For once in this damn administration, go figure out what the problems are, propose a real solution and send us the damn bill.

    1. Great information and points, Jeff. Thanks for the perspective.

      And I agree, taking care of our aged and vulnerable vets should be something that is beyond politics, and should be near the point of "pay any price, bear any burden." Yet the Fitzwalkerstanis still play games, which is disgusting.