Overview of the Chelsea Soldiers’ Home

This section describes the makeup and responsibilities of the Chelsea Soldiers’ Home.

Overview

The Chelsea Soldiers’ Home (CHE) was established in 1882 to provide various healthcare services to eligible Commonwealth veterans. Under Chapter 115A of the Massachusetts General Laws, CHE operates within the Department of Veterans’ Services, which is part of the Executive Office of Health and Human Services. CHE’s website states,

Our mission is to provide the highest level of comprehensive care, while always respecting the [psychosocial], spiritual and cultural needs for our veterans [and] their families, and always striving to extend comfort, dignity and responsive care to all of our patients.

CHE’s campus offers skilled nursing, care for veterans with Alzheimer’s disease, and other long-term care. CHE currently serves 293 veterans, of whom 121 are in a hospital and 172 live in dormitories. CHE also has a library, a barbershop, recreation rooms, a dining room, a canteen, and a pharmacy. Several religious services are also available to veterans. The campus has its own police force and a medical and fire emergency system. Full-time residential housing is provided in a 172-bed Dormitory Unit consisting of five buildings on CHE’s 20-acre campus. As of September 2019, 172 of its beds had occupants; 107 were Vietnam War veterans, 38 were peacetime veterans, 18 were Gulf War veterans, 6 were Iraq War veterans, 2 were veterans of the 1950–1953 Korea conflict, and 1 was a World War II veteran. Finally, CHE has a 130-bed long-term-care facility in the Quigley Memorial Hospital in Chelsea that provides skilled nursing and services related to dementia and Alzheimer’s disease. As of September 2019, CHE records showed that 121 of its beds had occupants; 54 were Vietnam War veterans, 34 were World War II veterans, 31 were veterans of Korea conflict, and 2 were peacetime veterans.

CHE is also constructing a new long-term-care facility for its residents. The project has an estimated cost of $199,000,000 and is scheduled to be finished in summer 2022. The new facility will cover approximately 247,000 square feet and will comply with the design guidelines and service delivery requirements of the federal Department of Veterans Affairs.

CHE is governed by a seven-member board of trustees, of which five members must be veterans, appointed by the Secretary of the Executive Office of Health and Human Services (EOHHS), with the Governor’s approval, to oversee CHE’s management. Its day-to-day operations are administered by a superintendent who is also appointed by the Secretary of EOHHS with the Governor’s approval.

During the audit period, CHE had 333 employees. Of these, 169 were nursing and medical personnel; 18 were administration and finance personnel; 117 worked in day-to-day operations; and 29 worked in residential services, which include social service and social work. For the audit period, CHE’s state appropriations totaled $54,497,065. The payroll expenses during the audit period totaled $41,876,286, including $4,119,436 of overtime expenses. Of the total overtime expense amount, $3,320,033 (81%) was expended on nursing and medical personnel. The table below shows the overtime expenditures for nursing and medical personnel by position during the audit period.

CHE Total Earnings by Nursing and Medical Staff Department Position

Position	Sum of Overtime Paid	Sum of Overtime Hours Worked	Number of Employees
Nursing Assistant I	$1,494,648	56,383	89
Registered Nurse II	749,240	10,571	21
Licensed Practical Nurse II	688,185	15,907	31
Registered Nurse III	220,529	3,279	8
Licensed Practical Nurse I	134,774	3,748	10
Nursing Assistant II	13,412	505	2
Registered Nurse V	9,525	109	2
Registered Nurse IV	9,441	117	1
Physician II/III	242	3	2
Registered Nurse I	37	1	1
Nurse Practitioner	0	0	2
Total	$3,320,033	90,623	169

Background on Overtime at CHE

CHE’s nursing and medical staff, under CHE’s collective bargaining agreements (CBAs) for Unit 2 (Service Employees International Union Local 888) and Unit 7 (Massachusetts Nursing Association State Chapter of Health Care Professionals), are eligible for overtime. CHE requires that any overtime earned by employees be in accordance with both CBAs. According to Section 7.2 of both CBAs in effect during our audit period, there are two types of overtime for the nursing staff: premium and straight. Premium overtime is work that exceeds 8 hours per day or 40 hours per week, paid at more than the standard hourly rate. In contrast, straight overtime is work that exceeds a worker’s scheduled hours but does not exceed 8 hours per day or 40 hours per week, paid at the standard hourly rate. To earn payment for either type of overtime, nursing personnel must obtain preapproval from their supervisors through the Overtime Request Form (see Appendix). This form is completed by a nurse requesting overtime and submitted to the nursing supervisor for preapproval before the nurse can work the overtime. In emergencies, the nurse can work the overtime without preapproval but must complete the form after the emergency ends.

CHE also uses two forms, the Daily Staffing Schedule and the Weekly Overtime Summary Form, for tracking and scheduling regular and overtime employee hours worked:

• The Daily Staffing Schedule is completed by the nurse who manages the nursing staff for that particular day. It is a daily roster used to allocate and track staff members and record overtime. It also ensures that the Nursing Department maintains at least the minimum staffing level for every shift.
• The Weekly Overtime Summary Form is completed by the overnight nursing supervisors and authorized by the director of nursing. It records who worked overtime, the actual overtime hours worked, the reason for the overtime, the unit where the overtime was worked, the person being replaced (if any), and the supervisor’s initial. The form lists nine instances where overtime is warranted:

1. An employee is out under the Family and Medical Leave Act.
2. An employee has suffered an accident while at work and is expected to be absent for a period of time.
3. A shift is vacant because a position is open.
4. An employee has called in sick.
5. An employee is taking vacation.
6. A resident needs specialized or one-on-one care for a period of time, and this is not accounted for in the schedule.
7. An employee has been asked to come in for training at a specific time.
8. Staff members have been reassigned.
9. Other reasons based on medical or clinical need to ensure proper hours per day.

We used the CBA requirements, as well as the CHE overtime policy that was in effect during our audit period, as our criteria when performing our audit testing.

Nursing Staff Overtime

CHE requires nursing staff members (in non-management nursing positions) to use a time collection device (TCD) to clock in for shifts, clock out for unpaid meal periods, and clock out at the end of shifts. The TCD automatically submits the times they clock in and out to the Self-Service Time and Attendance (SSTA) program operated by the Executive Office for Administration and Finance. According to CHE officials, overtime shifts are assigned on a first-come, first-served basis by nursing seniority. When overtime becomes available, nursing supervisors use a list of nurses in order of seniority to notify the next eligible nurse by a phone call (or in person if s/he is currently working a scheduled shift). The nurse can then decide whether to work overtime. If that nurse declines the overtime, it is made available to the next nurse on the seniority list. All nurses must be given an opportunity for overtime before any one nurse becomes eligible again.

CHE nursing management during our audit period consisted of eight registered nurses, one assistant director of nursing, and two directors of nursing. Employees in these positions are not required to use the TCD but must report their hours worked each day in SSTA. Timesheets for nursing personnel are approved by nurses’ direct supervisors at the end of each week. Overtime for nursing management does not have to be preapproved.

Premium and Standard Overtime

Premium overtime is work that exceeds 8 hours per day or 40 hours per week; it is paid at more than the standard hourly rate. In contrast, standard overtime is work that exceeds a worker’s scheduled hours but does not exceed 8 hours per day or 40 hours per week; it is paid at the standard hourly rate.

Incremental Overtime

CHE nursing personnel can accumulate incremental overtime by clocking in early before shifts, clocking out after scheduled shifts, and/or not clocking out for unpaid meal periods.

Date published:	March 30, 2021