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Wisconsin Veterans Homes

Wisconsin Veterans Homes. Legislative Audit Bureau March 2011. Areas of Review. Admissions policies and resident services Revenues and expenditures Staffing levels and compliance with state and federal regulations for nursing staff Administration of the Aid to Indigent Veterans program

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Wisconsin Veterans Homes

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  1. Wisconsin Veterans Homes Legislative Audit Bureau March 2011

  2. Areas of Review • Admissions policies and resident services • Revenues and expenditures • Staffing levels and compliance with state and federal regulations for nursing staff • Administration of the Aid to Indigent Veterans program • Purchasing procedures

  3. Facilities Operated by DVA • The home at King opened in 1887. • The home at Union Grove opened in 2001 to provide assisted living care, and it expanded in 2006 to include skilled nursing care. • A new 72-bed nursing facility is scheduled to open in Chippewa Falls in November 2012.

  4. Occupancy Trends

  5. Veterans Home Funding Sources • State and federal Medical Assistance payments • Payments by residents at private pay rates • Federal per diem payments for all residents who are veterans • Federal Medicare payments at Union Grove only • Federal funding for veterans with service-connected disabilities

  6. Operating Expenditures • Salaries and fringe benefits accounted for $65.7 million (73 percent) of FY 2008-09 expenditures. • Expenditures increased from $54.6 million in FY 2004-05 to $89.7 million in FY 2008‑09. • Expenditures have exceeded revenues in four of the past five fiscal years. • A one-time $20.1 million Medical Assistance reimbursement rate adjustment made in FY 2005-06 has helped the homes remain solvent.

  7. Compliance with Federal and State Nursing Requirements • Nursing positions account for more than one-half of all permanent positions. • The homes met or exceeded federal and state requirements for the provision of nursing care.

  8. Expenditures for AdditionalNursing Time

  9. Overtime and Position Cost Comparison for Nursing Staff

  10. Full-time Nursing Staff Retention Rates

  11. Stipend Programs for Nurses • To help recruit and retain nursing staff, King established two stipend programs. • 57 nursing students participated from FY 2004-05 through FY 2008-09. • Expenditures totaled approximately $300,000, excluding participant wages.

  12. Inspections of Veterans Homes • The homes are subject to annual, unannounced inspections. • From 2005 through 2009, the number of citations the homes received was comparable to the statewide average. • Noncompliance with life safety codes was the most common type of citation. • King was issued one citation for substandard quality of care. • The homes responded to the citations they received.

  13. Aid to Indigent Veterans Program • The program provides financial assistance to help fund the cost of assisted living care at Union Grove. • The program was initially funded with segregated revenue from the Veterans Trust Fund. • GPR was added in the 2007-09 biennium, and Trust Fund revenue was replaced by program revenue from the homes’ operating appropriation. • The budget grew from $208,700 in FY 2005-06 to $406,700 in FY 2010-11.

  14. Concerns with the Aid to Indigent Veterans Program • The program was created in June 2005, but formal policies were not developed until May 2008. • In four cases, participants’ assets appeared to have exceeded the $2,000 eligibility limit. • One participant reported $386,000 in an irrevocable trust that was later found to be revocable.

  15. Purchasing and Contracting • In FY 2008-09, the homes purchased $17.0 million in goods and services. • We found violations of purchasing requirements for 26 of 79 purchases we reviewed. • There were four types of violations: • Split purchasing • Misapplication of bidding procedures • Inadequate bid solicitation • Failure to rebid contracts

  16. Oversight and Accountability • Ambiguous policies and inadequate oversight have led to significant financial and program management concerns. • King used $50,000 appropriated for nursing education as unrestricted donations to Fox Valley Technical College. • Numerous administrative changes have raised concerns about stability and continuity of agency leadership. • Personnel problems related to the veterans homes are long-standing. • Since at least 2006, DVA has planned to develop a comprehensive long-term financial plan for the homes but has not done so.

  17. Audit Recommendations • We include several recommendations for DVA, including reporting to the Joint Legislative Audit Committee by July 1 on the specific steps it has taken to respond to our recommendations.

  18. Wisconsin Veterans Homes Legislative Audit Bureau March 2011

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