Nursing homes under scrutiny

The state is threatening to yank the licenses of two Coeur d’Alene nursing homes at the end of the year for failing to protect residents from accidents, care properly for wounds, provide enough nursing services, adequately train their staffs and more.

But Life Care of Coeur d’Alene and Pinewood Care Center have submitted plans, as required, to correct problems, said Tom Shanahan, spokesman for the state Department of Health and Welfare’s Bureau of Facilities Standards.

“We’re going through those now and will work with them if any changes need to be made,” Shanahan said Friday. “They also gave us a date when they’ll be back in compliance. Today is Pinewood’s date.”

Life Care is disputing the findings from its June inspection, which resulted in a recommendation that the Centers for Medicare and Medicaid Services impose a $10,000 fine. A panel will most likely hear its appeal in September, Shanahan said. Still, the care center tentatively set Aug. 8 as the day it will be in compliance with state and federal nursing home requirements, he said.

A June inspection of Pinewood exposed such problems as nurse’s aides dropping a resident, fracturing her shoulder and not recognizing the injury or responding with more than Tylenol for three days. Pinewood was cited for such poor lighting in resident rooms that nurses used penlights to see wounds they were treating.

Inspectors also cited the nursing home for allowing four residents to develop bedsores so aggravated they placed the patients in immediate danger. Two days after the survey, Pinewood contracted with a therapy service that treats bedsores and the “immediate danger” designation was lifted, according to the survey report.

Inspectors filed a 92-page report on Pinewood, filled with eyewitness accounts of staff not washing hands and not raising a patient’s head to administer an oral medication, and resident complaints about infrequent baths – one per week. Surveyors also cited Pinewood for not keeping up with training for 17 of 34 certified nurse’s aides.

“Pinewood is disappointed in the state findings and disagrees with the conclusions,” facility director Rochelle Frank wrote in response to a reporter’s questions. “We promptly and thoroughly provided the plan of correction to the state addressing all issues in the survey. (I) fully expect that the state will resurvey us soon and determine we are in substantial compliance with all requirements. We have done a clinical review of all systems to ensure our residents continue to receive the quality of care they deserve.”

Life Care’s June surveyors determined its Coeur d’Alene center was so short-staffed that its director of nursing worked as a certified nurse’s aide at least once when only three nurse’s aides were on duty for 114 residents. It was cited for not listening to family groups that present administrators with requests for changes on the residents’ behalf.

It also was cited for a rash of accidents, from residents rolling out of bed to burning themselves with spilled coffee, not updating doctors or care plans as residents’ conditions changed, failing to follow physicians’ orders regarding dispensing of medication, and allowing pressure sores to place residents’ health in jeopardy. The immediate jeopardy designation was dropped after Life Care called in doctors to care for the sores.

The survey includes an account of a family member asking the surveyor for help.

“A random family member approached the surveyor and indicated that she had found a confused resident outside alone in her wheelchair and had assisted her back into the facility,” the report states.

The surveyor also reported that residents said they heard staff talking about the center being short-handed, and that the talk scared the residents.

“Several voiced concerns that a lot of staff are quitting and asked how the facility was dealing with this,” the report states. “The residents stated that the staff try to take care of us, they are just overworked.”

Life Care Administrator Jeffrey Hill said that although he is appealing the state’s findings, he takes them seriously.

“We certainly consider ourselves a partner with the state and will fully cooperate with state officials through the review,” said Hill, who became Life Care’s director four months ago. “I feel we’re working toward good outcomes and positive resolutions of concerns.”

Hill said a clinical nurse who once was a facilities surveyor for Idaho is helping his center work toward state compliance.

“We take great pride in the care services we provide,” he said. “I certainly feel we have dedicated caregivers who work extremely hard.”

The Bureau of Facilities Standards prohibited both facilities from admitting new residents until the State Survey Agency verifies they’ve achieved substantial compliance.

Shanahan said inspectors will drop in unannounced for the verification surveys.

Jan Young, senior ombudsman for Aging and Adult Services in Coeur d’Alene, said North Idaho can’t afford any closed nursing homes.

“Other facilities are accommodating and do what they can, but there are only so many beds,” Young said.

She visits nursing homes and assisted living centers throughout North Idaho about once each month and talks with residents, families, staff and administrators to assess satisfaction.

“Nursing homes always have complaints. It’s what that facility does when things happen that counts,” she said. “I think both these facilities will be OK.”