People who visited loved ones or lived at Holly Lane Rehabilitation and Healthcare Center in Nampa say they witnessed residents in agony and left open to abuse and neglect sometimes years before the same conditions prompted recent federal and state sanctions against the nursing home.
Robert Rood, 28, was so frustrated with being left unattended and in soiled clothing that he stopped eating and drinking. His experience was among those that prompted the Centers for Medicare and Medicaid Services to take immediate action, banning Holly Lane from taking new patients. He is now at a nursing home in Coeur d’Alene.
Boise’s Kevin Woolum said he checked his 86-year-old father into Holly Lane in May 2014 and checked Harry Woolum out less than a week later due to concerns that aides were not removing fluid from his father’s lungs. His father died soon after.
Woolum got his father a dry-erase board to communicate.
“I said, ‘How you doing?’ and he says, ‘Get me out of here,’ and he started to cry,” Kevin Woolum told the Statesman. “The end days for your loved ones are hard anyway, but they need to realize that people need to have dignity in their last days.”
Carol Crist sent a long letter to the Idaho Commission on Aging in 2010, saying her brother, who had cirrhosis, was admitted to Holly Lane for palliative care in his final days.
“What concerned me, and caused me to find another skilled nursing facility, was the lack of attention paid to a vulnerable and helpless individual,” she wrote.
More than 10 people contacted the Statesman to tell their stories. Many declined to be quoted, but echoed observations by state inspectors in July: patients left to sit in their urine and feces, and patients ending up in the hospital due to preventable infections and poor staffing.
Holly’s staff is committed to providing quality services in a homelike environment. Despite the good intentions of all involved, however, we acknowledge that some improvements were necessary.
Mikki Meer, chief operating officer, Orianna Health Systems
A nursing assistant told the inspector that Rood needed help from two people to go to the bathroom and, because of short staffing, it was easier to just change his soiled clothes than to help him avoid being incontinent.
“He told me, ‘If I have to piss and s--- on myself, I would rather be dead,’ ” his mother told the state inspector. “I have been in tears a lot of times to see him that way.”
Rood’s family contacted the Statesman this week. In an interview, Robert told the Statesman he was given no real choice but to go to Holly Lane.
Rood became quadriplegic and needed a ventilator to breathe after being hit by a truck on State Street at age 10. His mother, Julia Rood, cared for him in their Boise home until 2011.
Read the first story: Nampa nursing home under scrutiny for harming residents
“Then I let him go into Trinity Mission,” she said, referring to Holly Lane’s former name. “It was pretty good for a year, and then he suffered acute lung failure there in 2013.”
He was sent to a hospital, then home, as Julia Rood tried to keep him out of Holly Lane. He lived at the St. Luke’s intensive care unit for nine months. The family then arranged for Robert to live in an apartment, but he got just four hours of nursing care per day, Robert and Julia Rood said. He went back to a hospital from the apartment after six days.
Robert eventually was admitted to Holly Lane again.
“And he was hospitalized four times in six weeks” due to poor care from the nursing home, Julia Rood said. “He suffered a lung injury while he was there, and pneumonia and MRSA.”
MRSA is a dangerous, antibiotic-resistant staph infection.
Robert lost 69 pounds during the two months he was at the nursing home, Julia Rood said, adding that she contacted adult protection services and a member of Congress to complain.
Robert told the Statesman this week that if he could choose anything, he would live in an apartment or home in Boise.
The Idaho Health and Welfare Department team spent five days at Holly Lane in July after receiving complaints in June. The team said eight residents were “in immediate jeopardy of serious harm, impairment or death,” and Holly Lane’s practices “resulted in serious harm, injury or death for three of four sampled residents.”
Mikki Meer, chief operating officer of Orianna Health Systems — the Tennessee company that owns Holly Lane as well as Midland Rehabilitation and Healthcare Center in Nampa — did not respond to a request for an interview. She sent comments via email.
“You should know that the facility staff, along with regional and corporate support staff, have been working diligently for many weeks to resolve concerns cited by the Idaho regulatory agency after the July survey,” Meer wrote. “Our focus and the Holly Lane staff’s focus has and will remain on ensuring that the facility provides the best care possible so that it can continue its important service to the community.”
Our focus and the Holly Lane staff’s focus has been and will remain on ensuring that the facility provides the best care possible.
Mikki Meer, chief operating officer of Orianna Health Systems
Meer told the Statesman last month that Orianna took the “allegations submitted by the state very seriously” but did not “necessarily agree with all of the allegations.” She declined to talk in detail and declined a request from the Statesman to tour the facility, citing privacy and legal reasons.
PROBLEMS NOT UNIVERSAL
Holly Lane “used to be the Cadillac facility of the valley,” said Kandi Andreason, a licensed practical nurse from Middleton. “It’s where everybody wanted to be.”
Those of us who’ve done this and it’s a passion to us, those kinds of things are frustrating and they make me so angry.
Kandi Andreason, licensed practical nurse in Boise, specializing in long-term care
Andreason, a nurse for 27 years, said she worked at Holly Lane from 2001 to 2004. Her own father was a patient at Holly Lane in 2003 after a major surgery to amputate part of his leg.
At the time, the nursing home had a “fabulous” therapy department, Andreason said.
When Andreason worked there, Holly Lane did not have a ventilator unit — which offers special care and equipment for people who cannot breathe on their own.
Andreason now works at Shaw Mountain of Cascadia nursing home in Boise.
Nursing home deaths and injuries are doubly distressing because they can tarnish the perception of all facilities, she said.
“The things I was reading in that article, when you’ve done this kind of work ... those things just make you angry,” she told the Statesman this week. “I was so mad, I had tears running down my face.”
LOW WAGES AND UNDERSTAFFING
A major red flag unearthed by state inspectors in July was a lack of adequate staffing.
Idaho does not have any regulations that say health care businesses must have a certain ratio of nurses per patient.
Meer, the chief operating officer of Orianna, said Holly Lane figures out its nursing schedule based on “acuity,” or the level of need for each patient. Some people in a nursing home can talk, brush their own teeth and dress themselves. Others need two or three people to go to the bathroom and breathe normally.
4.1 hours The amount of daily nursing care a patient gets in adequately staffed nursing homes, according to UCSF nursing professor Charlene Harrington
2.4 hours The amount Holly Lane patients were getting in April 2015, according to federal data
State officials said staffing is a constant challenge at nursing homes around the state and the country, due to low wages for backbreaking work.
“I think the reason for the various staffing levels that you see are probably as varied as the staffing levels ... because whoever runs the nursing home is trying to run a business as well as caring for people,” said Tamara Prisock, who heads the state division of licensing and certification.
Her division is responsible for nursing home inspections, but it also is short-staffed.
With furious growth in the health care industry, the division’s workload has grown. Prisock is having trouble filling vacancies because of the comparatively low pay, she said. The entry-level wage is $25 to $27 an hour, regardless of where the inspector lives, according to Bureau of Facility Standards chief Debby Ransom.
“Candidates are telling us we’re asking them to take a $7 or $8 an hour pay cut,” Prisock said.
As a result, the bureau has hired a contractor to do some of its inspections.
The average nursing assistant in the Boise metro area makes $11.69 an hour, according to federal labor data. Those workers could make more as landscapers, retail clerks, telemarketers or data-entry specialists — jobs that do not require lifting hundreds of pounds, cleaning bed pans or risking an attack from a scared and confused patient.
Other nursing home jobs, such as registered nurse or respiratory therapist, pay more — $19.34 and $34.91 an hour, respectively. But those average wages are calculated from employees not just at nursing homes, but also hospitals, private practices and other workplaces.
Nursing homes that get into trouble “are trying to make profits when the pay (from Medicaid) is low, and they do that by jeopardizing adequate care,” said Charlene Harrington, professor of nursing at University of California San Francisco. “It’s a question of paying adequately and hiring enough to do the job.”
Researchers have found that relatively low Medicaid payment rates to nursing homes make it harder to adequately staff those homes, she said. But raising Medicaid rates alone isn’t enough: States have to enforce staffing minimums to make sure the money is spent on patients instead of profits, she said.
WHAT CAN YOU DO?
Before choosing a nursing home for your loved one, get informed. Nursing homes are required to make their current inspection reports available. If the reports aren’t displayed prominently, ask to see them. “Most people don’t look at them, but that survey can tell you an awful lot about what’s going on there,” said Kandi Andreason, a licensed practical nurse who has worked at local nursing homes.
Are you seeing problems at a nursing home or any other health care facility? You can file a complaint by calling (208) 334-6626 (choose option 5) or sending an email to firstname.lastname@example.org.
In your complaint:
▪ Provide the name of the facility; the patient and/or employee’s name; the incident date; and a description.
▪ Do not wait a month or a year to file your complaint. That may be too late for the bureau to take action.
▪ Give details. Instead of “They are understaffed,” tell the bureau, “They sent three employees home early at 10 p.m., and that caused my loved one to sit in a wheelchair all night.”