Pay gap at Minneapolis Veterans Home is factor in care

03/20/2007

By Pat Doyle, Star Tribune
Last update: March 19, 2007


Nurses and aides at the troubled Minneapolis Veterans Home complained for years that their pay was too low and their hours too long, and that those conditions have contributed to repeated health and safety violations.
Budget figures and an arbitrator's opinion lend support to their arguments.

Spending on nursing at the Veterans Home didn't keep pace with inflation from 2001 to 2005, then increased sharply last year in response to a series of violations at the facility.

During years when a shortage of nurses boosted their value in the Twin Cities job market, nurses at the Veterans Home earned substantially less than they would at metro hospitals. Today, a top-scale registered nurse at a Twin Cities hospital can make $14,600 more in a year than one working at the Veterans Home.

The pay gap, high turnover and mandatory overtime led to a scheduling problem that "probably does contribute to heightened health and safety risks for patients and nurses," wrote arbitrator Mario Bognanno in reviewing a pay dispute in 2004.

At the time, however, because of the state's financial troubles, Bognanno ruled against nurses who were seeking more money through arbitration. Gov. Tim Pawlenty and the Legislature had opted for budget cuts and freezes, rather than tax increases.

The state pays the biggest share of funding for the Veterans Home, with the federal government and residents also contributing. How much it spends on nursing-related care, and on building repairs and other improvements, has become more important in the aftermath of violations at the facility over the past couple of years.

The deaths of three residents in January after medication errors or neglect prompted a recent round of legislative hearings; lawmakers in 2005 looked into similar problems.

That wage gap didn't always exist.

Nurses at the Veterans Home and other state institutions earned wages comparable to those of workers at private Twin Cities hospitals until the early 1990s when the hospital workers began getting bigger annual increases. The disparity widened in 2004 and 2005, when wages for registered nurses at the Veterans Home and other state facilities were frozen.

Veterans Home officials have argued that their nurses' pay is competitive with those in nursing homes -- a comparison they say is more valid than hospitals. The nurses union counters that the Veterans Home isn't a true nursing home, but a hybrid of a nursing home and hospital.

Despite ruling against the nurses, Bognanno said there was a more important issue than comparisons between hospitals and nursing homes.

"They both compete for nursing services by tapping into the same stock of nurse supply," he wrote. "As a result ... if a wage gap should develop between them, then nurses will move from the low- to the high-paying market."

Problem working conditions

Margaret Skoy, a Veterans Home RN, testified at a legislative hearing in 2005 that administrators had cut staffing a few years earlier on each skilled care unit -- from four RNs to three, and from eight nurses aides to four -- and that an aide's workload "dramatically increased."

She also testified that nurses and aides were being required to work double shifts, sometimes 16-hour days two or three times in a 10-day period.

"It causes increased stress and exhaustion," Skoy told legislators. "It negatively impacts their ability to give quality care to our veterans."

Since Bognanno's ruling, nurses have gotten raises. But Sen. Linda Berglin, DFL-Minneapolis, who chairs a committee that oversees the Veterans Home, last year questioned its officials on whether their pay level was adequate.

She said she received assurances in December that the pay had improved sufficiently.

After violations became public in September 2005, the Veterans Home got an additional $4 million from the state to hire nursing-related help. It spent the money creating 42 positions, mostly nurses aides, according to financial director Douglas Rickabaugh.

Registered nurses at the Veterans Home got better raises in 2006 than many other state employees, in recognition of marketplace and turnover issues. But there remained about a $2.50-an-hour gap between starting RNs at the Veterans Home and those in private metro hospitals. The gap for top-scale RNs is about $7 an hour.

Pawlenty has agreed to a Veterans Home request for 3.3 percent raises for the next two years for nurses and other employees who deal directly with residents.

Veterans Home officials also say they went four years without money for repairs and upkeep of their buildings.

Rickabaugh said the Department of Finance turned down a request for $2 million in 2005 to pay for maintenance.

"We were strongly encouraged to live within our means," he said, unless it was an emergency request.

McClung said he believes the administration fulfilled all Veterans Home requests in the past. The governor has agreed to the Veterans Homes Board request for $8 million over the next two years to clear up a backlog of repairs for the Minneapolis facility and four others in the state. It's part of nearly $15 million that Pawlenty has recommended for the five facilities during that period.

Rickabaugh rattled off a list of projects at the Minneapolis Veterans Home that can use the money. "Handrails, corridor refinishing, ceilings, lighting, mechanical, replace flooring in resident rooms and hallways, dining room ceiling, all kinds of interior repair. Water heaters, roof repair, leaking commodes.

"There's many, many, many things."