The Capital Times’ Kateltyn Ferral has been all over the sickening developments at the King Homes, and she noted the LAB audit reiterated that the state continued to take in big money from the federal government to help pay for operations at King, but much of that money wasn’t used to maintain and improve conditions at King. Which led to scenes like this.
According to the audit, the department generated surplus revenue from King, but did not have a plan for how to allocate that money and did not make improvements to the facility promptly. Staff at King provided care to an average of 685 veterans and their spouses each day, bringing in more revenue as the number of residents at the home increased.The transfers to Union Grove happened between 2004 and 2013 to keep it afloat, but ultimately the smaller of the facility’s two skilled nursing facilities was closed in 2011 due to insufficient demand, and another facility was converted into an outpatient clinic.
From July 2011 through December 2016, 19 of the 29 capital projects King requested were initiated, but not all were initiated promptly, "including the replacement of soiled carpeting in one of its skilled nursing facilities that took more than seven years to initiate," according to the audit. It also did not create a 10-year facilities plan for the home, according to the audit.
The money transfers included $28.4 million to the Wisconsin Veterans Home at Union Grove and $20.1 million to the Veterans Trust Fund.
The largest of the transfers to the Veterans Trust Fund started with $12.0 million being sent over in 2015-16 by the Walker Administration and another $9 million was sent in this fiscal year, with no oversight allowed to the Joint Finance Committee or other areas of the State Legislature. In an interesting twist, the JFC is scheduled to discuss the Veterans Trust Fund next week. Here's some of the Legislative Fiscal Bureau's summary of these issues.
The unappropriated balance in the Department's appropriation for institutional operations at the state veterans homes was $50.8 million in 2015-16, and is projected to exceed $54 million in 2016-17. The Department indicates that the homes are expected to generate sufficient excess revenues to support anticipated transfers to the VTF in the 2017-19 biennium (the paper indicates the 2017-19 transfers will total $26 million).And what could that money have been used for instead of to fill budget holes? The LAB says improved amenities and staffing could help residents have a better experience, and that there are plenty of big-ticket building projects at King waiting to be worked on.
9. The state veterans homes program revenue appropriation receives revenue primarily from the medical assistance (MA) program, federal veterans per diem payments, payments by residents, federal service-connected disability payments, and Medicare. Historically, MA program payments have been the largest source of revenue and are the primary reason that, in recent years, the unappropriated PR balance has continued to increase. MA program payments to the state veterans homes are based on the Medicare upper limit payment methodology, which can exceed the actual, average cost of providing care. This is particularly the case since federal per diem payments received on behalf of residents who are veterans are not counted as an offsetting revenue when calculating the payment. As long as the homes remain at or near capacity, as they have been in recent years, the Department expects that revenues will exceed the cost of providing care at those facilities.
In addition, DVA (The Department of Veterans Affairs) may wish to consider whether some of the cash balance should be used to improve the overall quality of life for King residents, such as providing certain goods and services that have been eliminated or have not been funded in recent years as cost-savings measures but that have raised concerns among some residents, employees, and advocates for veterans. For example, in March 2016, DVA replaced its staffed coffee shop with vending machines and discontinued providing homemade food items, such as chicken and beef sandwiches. In March 2017, DVA indicated that it plans to restore the coffee shop.Among the list of items at King that the LAB says was requested at one point but have not been funded as of this time include:
DVA may also wish to consider whether the cash balance should be used to help improve employee satisfaction and retention. Examples of strategies used by other organizations include expanding training opportunities and instituting cash bonuses for employees who help to recruit resident care staff. However, efforts to address employee satisfaction and retention that involve payments to employees would likely require the approval of the Department of Administration (DOA). As noted, the second phase of our evaluation will provide additional analyses of staffing at King.
Finally, DVA could assess the extent to which these and other funds could be used to more promptly address deferred maintenance needs. In July 2016, DVA submitted to DOA a list of 21 deferred maintenance projects at King. Of these 21 projects, 3 projects totaling $5.7 million were included as part of DVA’s 2017-19 capital budget request, and funding for 18 projects totaling an estimated $11.1 million had not been requested through February 2017. Examples of these 18 projects include renovating the ceilings and floors of two residence halls ($3.7 million), renovating the fishing dock used by residents ($15,000), and replacing in a residence hall two sump pumps that are beyond their useful lives ($5,000). Appendix 2 provides a list of all deferred maintenance projects for King, including whether they may have a potential effect on resident safety.
1. $3.78 million upgrade HVAC systems in the buildings.
2. The $3.70 million to renovate ceilings and floors that is noted above (it was apparently requested in the past but not requested in 2017-19).
3. $2.91 million to replace the electrical system (this is part of the 2017-19 Capital budget).
4. $1.71 million to replace the nurse call system (also included in 2017-19 Capital budget).
Given that the federal government pays for 65% of these projects, the cost to the state to pay for all of these projects would have been just under $4.25 million. Or barely 1/3 of what was taken from the King Veterans Home account in 2015-16 and transferred to keep the Veterans Trust Fund solvent.
In other words, we could have chosen to use $4.25 million in taxpayer dollars to backfill the deficit in the Veterans Trust Fund (seems doable, given that we’re supposed to end 2017 with $453 million in the bank), AND paid for all of these requested high-cost items at the King Homes. In addition, the King Homes still would have had more money available to pay staff a fairer wage or hire more people, and/or could have taken care of other needs that didn’t require federal funding.
Instead, the Walker Administration chose to transfer $21 million in an attempt to avoid drawing attention to the fiscal issues, in the hope that service problems at King could be covered up. That didn’t really work out, now did it? And it's yet another example of the stunning incompetence and lack of caring that has defined the Scott Walker administration in Wisconsin.