Her face was bathed in tears as she was wheeled into Life Care Center of Coeur d’Alene.
Tears of joy.
“Look who’s here,” a staff member announced.
The spacious hallway was suddenly jammed, as nurses and administrators gathered around June Kangas, smiling and welcoming her back home.
Kangas, 79, has lived at Life Care since it opened in August 1996 and was one of several patients left in limbo when the state banned admissions at the nursing home.
After a stint at Kootenai Medical Center, the hospital sent her to another nursing home because the state prohibited Life Care from admitting patients for a month. The ban was the result of a state inspection that found the facility providing substandard care.
The ban was lifted last week after inspectors revisited the Coeur d’Alene nursing home, bringing relief to families who saw the action as draconian.
“Think of the patient who recovers (in the hospital) and is told she can’t go back to her home, where she had friends and belongings,” said Bill Goins, whose mother-in-law was in Life Care. “It’s devastating.”
Life Care’s sparkling, colonial-style building, plush with flowered wallpaper and matching new furniture, is the preferred long-term care facility for many families in the Coeur d’Alene area.
They say the food is tasty and attractively presented, the building doesn’t smell unpleasant, and the staff is friendly.
“I’ve been totally grateful to have this place,” said Sharon Seitz, whose mother, Ina Tascher, lives at Life Care. “This is so much better than where she was before.”
So how could such a nice place get in so much trouble?
Life Care’s rapid growth in the Northwest is partially to blame. Also, nursing homes tend to have a high turnover of caregivers who are expected to know each resident’s individual needs. And those needs are greater among nursing home residents today than they were in the past.
The state’s 113-page report on Life Care of Coeur d’Alene detailed dozens of cases where the staff neglected the health, safety and social needs of patients, kept poor records, and failed to notify family and physicians of health issues. Some inspectors witnessed what they considered verbal abuse of residents and a lack of concern for residents’ dignity.
Among the state’s findings were:
A resident who lost 37 pounds in eight weeks while taking improper medications , and who later died of heart failure;
A resident who was hospitalized after being given a drug when a physician had ordered it stopped;
Injuries that were never investigated by the staff.
Seitz and other supporters of Life Care believe that some of the instances detailed in the report are the exaggerations of overzealous inspectors, but Life Care’s corporate managers haven’t challenged the report’s findings.
Instead, they’ve devoted people and resources to the Coeur d’Alene facility to write a corrective plan and act on it.
Two nurses aides have been hired, as well as an additional registered nurse who will divide her time between Life Care facilities in Coeur d’Alene, Lewiston and Sandpoint.
“We realize that we need to provide more clinical help in the state of Idaho,” said Life Care spokesman Beecher Hunter. “With the addition of this person, we’ll have enough skill in the clinical area to be sure our clinical services do not slip.”
Hunter said the problems resulted from Life Care paying more attention to developing a Northwest division organization than to its individual facilities. The Tennessee-based company has more than 200 facilities in 28 states, and recently built four new facilities in Idaho and purchased 13 in Oregon and Washington.
State regulators believe Life Care grew too big, too fast in Idaho. In the last 15 months, the state has taken action against four of Life Care’s seven Idaho facilities. One was fined $50,000 and is now on a provisional license after a resident choked to death.
“We don’t believe they were ready for the difficulties they would encounter in this state,” said John Hathaway, head of facility standards in the Department of Health and Welfare. “We have a shortage of nurses willing to work in these facilities.”
Although they added employees, Coeur d’Alene Life Care’s director, Michelle Stelzer-O’Neill, said they haven’t been short-staffed or had a problem finding nurses.
Yet, she did acknowledge that Life Care, like most nursing homes, does have a fairly high turnover rate. Nursing homes are not the first choice for nurses looking for a good job.
“The pay scale for nurses is very poor in long-term facilities,” said Gretchen Dimico, president of the Idaho Nurses Association. “I don’t blame the organization - it’s the financial system.”
Medicare doesn’t reimburse long-term custodial care, she said. “It isn’t the institution, it’s how we prioritize our health care system.”
Nursing homes also have a high percentage of certified nurses aides, and are required by law to have them. Idaho also requires facilities with more than 60 residents to have at least two registered nurses.
Nurses aides “are the low man on the totem pole, salary-wise and status-wise,” said Joan Brogan, a nursing instructor at North Idaho College. Often, they’re working as a nurses aide while they go to school or look for something better, she said.
The state also requires nursing homes to staff so that each patient gets 2.4 hours of hands-on care a day. But that’s a “rock-bottom” requirement, Hathaway said.
“Today, nursing facilities that meet only that are in trouble with us,” he said.
Life Care Center of Coeur d’Alene is staffed for 3.8 hours of hands-on care a day, and has about 40 volunteers who drop in to visit and keep residents company. Even that doesn’t seem like enough, according to some observers.
“I thought they didn’t have enough help,” said Audrey Carter, whose 77-year-old sister used to live at Life Care. But her sister liked it there, and Carter didn’t see any big problems with the care otherwise.
“They weren’t standing around the nursing station. They were busy,” she said.
One reason even a well-staffed nursing home is kept hustling all day long is because of the high level of care its residents need. Transitional care facilities tend to take the more able-bodied elderly, while nursing homes get many senior citizens straight from the hospital.
Hospitals discharge patients much more quickly than in the past, and many wind up in nursing homes - at least temporarily.
“Sicker and quicker is a short-hand way of saying what’s happening in the buildings,” said Scott Spears, director of the Idaho Health Care Association. “Nursing homes are to a large degree reserved for the sickest.”
Add to all that the fact that the nursing home industry is heavily regulated by the state and federal government.
Many licensed nurses wind up spending more time on paperwork to meet federal and state requirements than with the patients, he said.
“There are over 500 some odd possible citations that a surveyor can hit a building with when they walk in the door,” Spears added. “They can walk in whenever they want to. The margin for error becomes very slim.”
Nursing homes in Idaho average 6.5 deficiencies per survey, while the national average is 4.8. Idaho has the 9th highest average in the nation - but Spears said the inspections are subjective enough to make comparisons meaningless.
“It all reflects to me the degree to which the agency wants to read the rules in black and white,” he said.
Seitz, who volunteers at Life Care, said that in all the hours she’s spent at the nursing home, she hasn’t seen the problems cited in the state’s report.
“Nobody can be everywhere at once,” she said of the staff. “But generally, they do a really good job.”
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