Who was looking out for vulnerable Nampa nursing home residents?

Holly Lane Rehabilitation and Healthcare Center is banned from accepting new or returning Medicare or Medicaid patients until it can prove it has fixed problems unearthed by a team of state inspectors in July.

The inspection found a widespread pattern of serious violations that threatened the health and safety of its residents. Some of the people living in the 120-bed nursing home — known until recently as Trinity Mission Health & Rehab of Holly — were found to be dehydrated, underfed, in pain, suffering harm and left unable to communicate, according to inspectors.

State nurses, social workers and dietitians found that a man who was severely dehydrated had died due to Holly Lane’s practices; that residents were left to sit in their own excrement for hours; and that nursing staff kept call-light buttons out of reach of residents or turned off call lights without responding to requests for help.

Read the story: Nampa nursing home under scrutiny for harming residents

The situation raised questions about the laws that protect vulnerable adults and about who is responsible for guaranteeing the safety of Idahoans who cannot survive without assistance.

Q: Why isn’t anyone in jail?

A: There are state and federal laws in place to protect people like Holly Lane’s nursing home residents from abuse, neglect or mistreatment. A few different government entities can bring criminal charges in a case where evidence shows a facility broke those laws. It is unclear whether any charges are coming.

When a Medicaid provider breaks the law, the Idaho Attorney General’s Medicaid Fraud Unit can pursue a criminal case, because it involves state funds. In a typical year, the unit gets referred several complaints of potential abuse and neglect. The unit investigated a total of 15 such cases between October 2014 and 2015, closing one with a criminal conviction. (The 2015-2016 numbers are not yet available.) Of those cases, six involved an assisted-living facility and one involved a nursing facility. The state did not criminally charge any facilities that year — just one individual. That was a typical year.

The AG’s office declined to say whether it is investigating Holly Lane. However, the Idaho Department of Health and Welfare told the Statesman on Monday that it has referred the case to the unit by sending over a copy of its findings.

Local police also could pursue a criminal case against a nursing home accused of abuse and neglect. That likely would start with police and be prosecuted by the county. The Nampa Police Department and Canyon County Prosecutor’s Office did not immediately respond Monday afternoon to requests for comment about their process for such cases.

Q: Why didn’t anyone notice the problems earlier?

A: According to Health and Welfare, someone filed complaints in June. Inspectors went out the next month to do the nursing home’s annual license survey in conjunction with a complaint investigation.

The department receives about 90 complaints a year against nursing homes. The Statesman found that Holly Lane had several violations in the past two years, but when inspectors dropped in on the nursing home, they did not find anything as severe as in July.

The state’s aging commission has an ombudsman program that Idaho Department of Health and Welfare works with, including contacting the ombudsman before doing an inspection. The ombudsman can file complaints on behalf of residents and is expected to visit nursing homes at least quarterly.

The ombudsman who is assigned to Canyon County did not respond to a message Monday seeking information about the office’s role at Holly Lane and other nursing homes.

Q: Why is Holly Lane still open?

A: The Idaho Department of Health and Welfare does have the authority to take emergency action to shut down a nursing home, according to IDHW spokeswoman Niki Forbing-Orr. Instead, the department gave Holly Lane the ability to operate without taking new patients until it proves it is back up to code.

The Nampa nursing home is the only one in the region that provides care for people who need ventilators to breathe, a spokesman for Health and Welfare said last week. The closest alternatives are in Coeur d’Alene and Utah. That, combined with how risky it is to transfer patients, makes shuttering the nursing home a last-choice option.

“Our role is really to work with facilities to help them come back into compliance,” Forbing-Orr said. “Ultimately, the most important consideration is what the residents need, and what their health and safety requirements are, and what’s available.”

The department also immediately notified the Centers for Medicare and Medicaid Services about Holly Lane’s worst violations. If the federal agency finds violations are bad enough, it can block a nursing home from having any government-insured patients under its care. CMS did not take that action against Holly Lane and rarely takes such drastic measures, Forbing-Orr said.

At the state level, the department allowed Holly Lane to repair the worst of its problems — the ones that put patients in harm’s way. The department learned of those severe problems in mid-July and went back in August to confirm they had been fixed.

“We confirmed that they had enough trained staff that was ready to work, and they knew what to do if they found neglect or abuse,” Forbing-Orr said. Inspectors went back to Holly Lane and “interviewed the staff, they watched them complete care, they quizzed them about ... neglect and abuse.”

But the sanctions in place already have caused problems. While Holly Lane is under an admissions ban, local people who need long-term ventilator nursing care must travel to get it.

Correction, 10/4/2016: An incorrect reference to Holly Lane receiving a provisional license was removed.

Audrey Dutton: 208-377-6448, @IDS_Audrey

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