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Executive Director Stephen Musser, launched an investigation of concerns about patient care. Musser says the review identified problems and he asked administrators at the Minneapolis home to take action. (MPR Photo/Laura McCallum)

Several nurses at the state-run Minneapolis Veterans Home say severe understaffing at the home led to patient injuries and medical errors. They told a legislative hearing that they were required to work 16-hour days, and a staffing shortage led to the numerous violations that a state inspection found two months ago. The acting administrator told lawmakers that the home is trying to fill vacant positions and fix the problems.

St. Paul, Minn. — In late July, the state health department conducted an unannounced inspection of the Minneapolis Veterans Home, where about 400 veterans live. The inspection found 31 violations, ranging from dirty conditions to incontinent residents who sat in wet and dirty pants for hours. The survey cited a staffing shortage.

Margaret Skoy, a nurse at the Veterans Home, told a joint hearing of three Senate committees that the number of nurses and nurses aides on each unit was cut three years ago. She says the workload increased dramatically, at a time when the home was getting patients with increasingly severe medical and mental problems. Then earlier this year, the home's former administrator decided to stop using temporary staff from outside agencies to fill nursing shortages, and required mandatory overtime for staff.

"Registered nurses, LPNs and nurses' aides were mandated to work 16-hour days, and had been mandated two to three double-shifts in a 10-day period at times," she said.

Skoy says the mandatory overtime was exhausting and stressful for nurses. She says 22 have left the Minneapolis Veterans Home in the last three months. The problems prompted the home's quality management director, Maria Ockenfels, to resign six months ago. Ockenfels, a registered nurse, says she was concerned about the staffing situation, which she says led to deteriorating patient care.

"There were two deaths related to falls. There was one resident who received 100 times a dose of morphine sulfate, because one of the factors was overtime," she said.

Ockenfels says she was told that the staffing shortage was due to a tight budget. After Ockenfels resigned, the Minnesota Veterans Home Board got involved. The board oversees the state's five veterans homes, including the Minneapolis facility.

Executive Director Stephen Musser, launched an investigation of Ockenfels' concerns. Musser says the review identified problems with patient care, and he asked administrators at the Minneapolis home to take action. Musser says when the health department inspection came out, it was clear that problems remained.

The home's top four administrators resigned, and Musser became acting administrator. He told lawmakers that the home is agressively recruiting more nursing staff.

"There's still much to do. But I believe we have the right people in the right spots to correct the deficiencies and move forward," Musser said.

Musser says the home has hired 32 nursing assistants for 40 vacant positions, and is only using mandatory overtime as a last resort. But DFL Sen. Linda Berglin of Minneapolis says she wonders what will happen down the road.

"Now I'm sure they're going to be staffing up, because they know they've got the spotlight on them. The question will be a year from now: are they still doing the job they should be doing there?"

Berglin, who chairs the Senate Health and Human Services Committee, believes the Veterans Board had enough money for adequate staffing in the past. She asked Musser about $7.8 million in unspent Veterans Homes Board funds. Musser couldn't account for the entire amount, and promised to get back to Berglin.

Supporters of the Minneapolis Veterans Home told lawmakers that the home has taken good care of many veterans. Kirk Larson, whose father has Alzheimer's and lives at the home, says he and many other family members have no complaints.

"It may be true that there are pockets of problems at the nursing home, but the attention that my dad has been given, and based on what the other people at the support group say, there is not a better place for them," he said.

Larson says for every violation cited in the health department survey, there are many stories of good care at the Veterans Home.

Lawmakers say they'll continue to monitor the home's progress. Gov. Pawlenty has asked the Veterans Home Board to review patient care, staffing, financing and other issues at all of the state's veterans homes.