PROVIDENCE, R.I. (WPRI) – A team of state officials is calling for changes at the embattled R.I. Veterans Home, including a reevaluation of staffing levels, addressing an issue of absentee workers and putting an end to a cleaning contract that’s nearly tripled in cost.
The so-called Tiger Team, formed in November by Democratic Gov. Gina Raimondo, spent two months reviewing operations, budgeting, staffing and finances at the long-term care facility for wartime veterans in Bristol. On Thursday the group released a much-anticipated report, revealing a host of challenges that can be traced back to when the $121 million home first opened in 2017.
“Many of the challenges we found at the [nursing home] are commonplace when moving from an aged, unsuitable building into a large-scale, modern facility that is nearly double the size of the former,” Maj. Gen. Christopher Callahan of the R.I. National Guard wrote in a letter to Raimondo.
Callahan, who led the Tiger Team, found one of the most significant challenges at the home for nearly 200 veterans was related to its medical and food-service staffing, which is structured in a way that too often results in employee shortages that drive up overtime and contract costs.
The home “reported there is an average of 5.6 medical staff call outs per day,” according to the report.
The home also suffers from short- and long-term absentee issues, including 21 employees that have been out for months, and a lack of oversight that has resulted in employees abusing the system. The team estimated the cost to the home at $1.6 million, and noted 16 medical personnel have resigned or been fired within the last year.
“The [home] does not have a time and attendance or overtime policy,” the team wrote. “The Team has inferred through conversations with … management staff that there is likely a culture of abusing overtime due to the lack of structure in personnel management.”
Callahan also pointed to a lack of oversight when it comes to spending for food, which is determined by the home’s annual budget rather than any cost-saving analysis based on need. A shortage in cooks has also created a staffing headache. Currently, the dietary department can only staff cooks five days a week without using overtime, according to the team, even though the Veterans Home is a 24/7 operation.
“Despite a decrease in resident census, the [home] continues to exceed their annual enacted dietary budget,” according to the team. “There is a lack of historical data available to explain this trend. The Team infers that the spending trend is related to an ineffective dietary budgeting mechanism and the development of the dietary menu based off the enacted budget, instead of building a budget based on cost per resident.”
The aesthetics, cleanliness and layout of the Veterans Home are often likened to a Marriott Hotel, and the Tiger Team noted that it was “extremely clean.” But the state officials also noted the housekeeping contract is $1.4 million at the new facility compared to $491,304 at the old facility.
“Renegotiate or terminate the current contract based on the availability of funds,” the team recommended.
Heritage Healthcare Services, a Cranston-based cleaning company, has held the contract for a decade. The company provides 35 housekeepers per day to keep the facility clean, which is an industry-standard based on the 256,111 square foot nursing home.
But the Tiger Team suggests the Veterans Home should be using a “cleanable square footage formula,” which would exclude the nursing home’s six kitchens. The calculation would reduce the required number of housekeepers to 24 employees per day, according to the report.
“We can probably draw down about 10 full time employee per day in the cleaning realm and keep the really high standards that are in place to keep the veterans home clean,” Callahan said.
The team also noted that the original contract was written in a way that “only one vendor competed for the contract due to the strict criteria written in the original [request for proposal].”
“The Team concluded that long term cost savings could be achieved by renegotiating the housekeeping contract, changing workflow processes within certain departments, and increasing staffing to reduce overtime costs,” according to the team.
The report’s release was paired with the announcement of the appointment of Paul Murgo, who will serve as interim administrator at the home. Rick Baccus, who previously served as its administrator, announced his resignation after Raimondo called for the creation of the Tiger Team.
“I’m pleased to have someone of Paul’s experience and skill set be part of what has become a truly collaborative approach to right-sizing the Veterans Home,” said Veterans Services Director Kasim Yarn in a statement. “I have no doubt that, together, we can make this beautiful facility financially stable and sustainable for generations to come.”
The state, meanwhile, has announced it will immediately reassign staff from other state agencies to help shore up operations at the Veterans Home.
The Tiger Team noted in its report that the home has no obvious health or safety concerns, but that there are several corrections that could improve its operations and finances.
“Our charge was to make recommendations that will stabilize spending and streamline operations without impacting the high level of care and quality of life that residents enjoy at the Home,” Callahan said in a statement.
Read the full report Tiger Team report here.
Lawmakers heard three bills regarding the RI Veterans Home Thursday night. In the video below, Kim Kalunian breaks down what the proposed legislation entails.