Report Faults Staff for Woes At Vets’ Home

Vt. Legislature-Funded Report Recommends Employee Changes

The Vermont Veterans’ Home in Bennington will come up $3.6 million short this year. The state already ponied up $1.5 million in the fiscal year 2014 budget, and the Shumlin administration has said it will look to come up with another $2 million in this year’s budget adjustment.

The facility has also run afoul of the federal government regulations twice in the last 18 months, and faces an unannounced inspection from regulators before Aug. 26. If the home doesn’t meet muster it could lose access to $7.1 million in Medicaid funding in addition to the estimated annual operating loss of $3.6 million.

According to a new report, there is plenty of blame to go around for the financial and organizational crisis.

The report, which was funded by the Legislature, found that everyone involved — the home’s administration, the state workers union and the board — is responsible for the current state of affairs at the veterans home.

Meanwhile, unless and until the nursing home that serves roughly 140 veterans gets its proverbial act together, the state is on the hook for the ongoing operating deficit in fiscal year 2014.

Gov. Peter Shumlin has said he will do everything he can to keep the home, which is one of the few big employers in Bennington, open. Lawmakers — especially Sen. Dick Sears, a Democrat who represents Bennington County and has close ties to the governor — also want to ensure that the veterans facility stays afloat.

Still, the Shumlin administration has made it clear that it can’t absorb $12 million in costs for the home on an annual basis.

The Vermont Veterans’ Home’s woes come at a time when lawmakers are concerned about how they’ll make ends meet in fiscal year 2015 with a built-in funding gap of $50 million and impending federal cuts to a wide range of programs Vermonters depend on. It’s unlikely, officials have said, that the state could make up the difference for Medicaid funding losses should the Centers for Medicare and Medicaid decertify the home.

And Reactions

The administration is faulted for poor leadership and management practices, and the Vermont State Employees Association, which represents 240 workers at the home, is blamed for becoming “too confrontational” and creating a difficult work environment, according to comments cited from a survey of staff conducted by the authors of the report, Health Care Management Associates.

Nevertheless, union representatives and the administrator of the facility agree the recommendations from Health Care Management Associates are constructive, even though some of the proposed changes aren’t necessarily palatable to all parties. Mike Pulling, of Health Care Management Associates, told lawmakers at a recent hearing that the management structure must be changed. He suggested that the home demote its current administrator, Melissa Jackson, and hire a subordinate as the new CEO. In addition, he said there are too many layers of management, and administrative staff should be exempt, not classified, employees. (Classified workers are protected by the union; exempt workers are employed at the will of the state.) Pulley said the home’s employment of only full-time classified staff is an anomaly in the nursing home business, and the facility should hire part-time staff to reduce overtime costs and employment of traveling nurses. Bennington has high staffing levels as compared with comparable facilities, Pulling said. Even so the work schedule, he said, should also be changed to ensure consistency of care at the facility.

He also recommended a cooling-off period for management and the VSEA.

Pulling said it could take a year for the home to turn its management and fiscal situation around.

Jackson, the administrator for the Vermont Veterans’ Home, who is the subject of much criticism from staff, says, “there is good and bad for all of us” in the report. “We will make changes where necessary,” Jackson said. “We are working with the board to improve the facility and make it financially viable.”

Workers feel vindicated by Pulling’s assessment of the situation. Rachel Fields, a VSEA member and licensed nursing assistant who works at the home, said the report “clearly spells out the management crisis we face at the Vermont Veterans’ Home.”

“Finally, someone listened to us,” Fields said. “The report says what we’ve been saying for two years now.”

Steve Howard, an organizer for VSEA, says the union surveyed members, canvassed 70 members in a door-to-door campaign and put out lawn signs to “call attention to the crisis.” The administration, he said, came under public pressure and wanted to squelch the union’s activities.

“We did everything in our power to have nurses be heard by management,” Howard said. “There was a tendency for people to want to sweep it under the rug. We said these folks, these frontline workers at Vermont Veterans’ Home, are not going away, they are experiencing a crisis.”

Howard and Fields say union members support the report’s recommendation for the hiring of part-time workers with benefits.

The report identified two problems that, if remedied, could help the home bring in more revenue. The administration has begun to require that patients to file Medicaid paperwork before entering the facility. In addition, the home hopes to attract vets who are on a waitlist for a Holyoke, Mass., facility to Bennington. This would increase the patient census for the Vermont Veterans’ Home and could dramatically boost revenues. There are currently about 140 patients at the facility; it could serve as many as 170.

Jeb Spaulding, the secretary of the Agency of Administration, and Jim Reardon, the commissioner of the Department of Finance and Management, have been involved in helping the home overcome its fiscal problems.

Spaulding suggested to lawmakers and the board of the Vermont Veterans’ Home that the facility hire a chief operating officer who would work with Jackson, the administrator.

“We really feel that given the current situation, stability is important, and there’s been a lot of turnover in recent years at VVH,” Spaulding said. “The governor is not recommending changes in management. We feel that would send the wrong message.”

The secretary said the home has made a lot of progress and the staff has pulled together. “We’re committed to building off the improvement,” Spaulding said.

The Shumlin administration, which is in the middle of negotiations with the union, has asked the VSEA to consider voluntarily creating a separate bargaining unit for health care employees who work at the state’s new psychiatric facility and the veterans home, he said.