Nursing Care Lax at Vets Home
Sep. 22–A lack of nursing care at the Minnesota Veterans Home in Minneapolis was the underlying cause of the home’s miserable showing in a recent state inspection. That was a source of agreement at Wednesday’s special legislative hearing to investigate why the home was cited for 33 violations of nursing home standards.
The cause of that shortfall is where the agreement ended. Current leaders, a former administrator and nursing officials took turns during the joint hearing of three Senate committees to blame one another.
The inspection report listed repeated instances in which the needs of veterans were neglected at the 418-bed South Minneapolis home. Inspectors reported nurses or assistants who left immobile veterans unattended for hours without moving them to prevent pressure ulcers or checking them for incontinence.
State Sen. Jim Vickerman, DFL-Tracy, opened the hearing determined to limit the amount of finger-pointing and to seek assurances that veterans will get better care.
In the end, the senator received some of those assurances. The home will report by Oct. 7 that it has corrected the deficiencies found in the state survey, said Stephen Musser, executive director of the state Veterans Homes Board, which oversees five homes in Minnesota. The home has added staff and increased its staff-to-patient ratio, he added.
But there was more blame than answers during three hours of testimony in St. Paul.
A group of current and former nurses at the home blamed administrators for leaving nursing positions unfilled and instituting mandatory overtime. Often nurses and assistants had to work 16-hour shifts, said Maria Ockenfels, who quit in March as the home’s quality management director.
“It was clear to me there was a deterioration in nursing care due to mandatory overtime,” Ockenfels said.
She linked the exhaustion caused by overtime to one instance in which a veteran received 100 times his prescribed dosage of a medication.
Musser blamed four administrators at the home for making dramatic changes to staff workloads without gaining the support of the nurses. He said those four administrators, who either resigned or were dismissed, had received repeated warnings from the state board to improve in several areas.
In the past year, Musser testified, the home had failed to reverse a troubling increase in infections, pressure ulcers, falls and other problems.
“That’s why those individuals are no longer here,” Musser said.
The former assistant administrator of the home, Fred Brumm, blamed nurses for the staffing shortfalls because of their excessive use of sick leave. He also blamed a limited budget to hire temporary nurses from employment agencies for forcing the unpopular overtime policy.
Brumm discussed other problems as well, from poor monitoring of veterans when they took their medication, to frustrating human resources policies that made it difficult to know the exact number of staff vacancies.
“These were handicapping conditions for which I and (the three other former administrators) were scapegoats,” he said.
State Sen. Linda Berglin, DFL-Minneapolis, said the ultimate responsibility lies with Musser and the Veterans Homes Board, which reviews all hiring decisions for veterans homes in Minneapolis and four other locations in the state.
“You should have known that there was a gap in terms of the staffing that was required at that facility,” she said.
Berglin, the chairwoman of the Senate’s Health and Human Services Budget Division, also cited state finance figures showing the state board had $7.8 million left from the last two-year budget period. She questioned how the money was used and whether it could have reduced staffing problems.
Staffing shortfalls and complaints from veterans started reaching the attention of regulatory officials at the Minnesota Department of Health earlier this year. The state conducted a spot inspection in June, and then moved up its regularly scheduled survey of the home to July.
Surveys from the past decade hadn’t resulted in more than eight violations at any one time against the veterans home, said David Giese, director of the Health Department’s division of complaint monitoring. The latest survey didn’t result in any violations showing imminent danger to veterans. But Giese said the number is a matter of “serious concern.”
The Health Department will conduct a follow-up inspection to ensure changes have been made. The U.S. Department of Veterans Affairs is likely to do the same.
Vickerman, who chairs the Senate’s Agriculture, Veterans and Gaming Committee, said the vets home leaders deserve time to prove they can fix the problems.
“I’m going to challenge you,” he said, “with getting the home where it belongs.”
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