Nursing Home Faces $5,000 Fine Mishandled Patient Abused Others, Agency Says; Center’S License Also On Probation

A local nursing home faces a $5,000 fine and a ban on accepting some new patients after an 87-year-old woman with Alzheimer’s repeatedly attacked other patients in her ward.

The woman lives at the LaCrosse Health and Rehabilitation Center, which runs a locked ward of about 20 patients with Alzheimer’s and other dementia, said Steve Holloway, LaCrosse’s administrator.

Every 12 to 15 months, the state Bureau of Facility Standards, which falls under the auspices of Health and Welfare, inspects Idaho’s nursing homes.

In June, the bureau showed up at LaCrosse unannounced, on a separate complaint. On that visit, they read the reports on the woman, which listed several incidents of verbal and physical abuse.

Inspectors decided to recommend a fine because the agency determined LaCrosse hadn’t handled the incidents properly. The bureau has placed the center’s license on probation until the problems are fixed.

“The deficiency was cited as an immediate jeopardy to residents’ health and safety,” said Debby Ransom, the bureau’s acting chief. “We recommend civil monetary penalties if the scope and severity of the deficient practice was at actual harm to residents …”

Holloway defended LaCrosse vigorously, saying staffers at the home did all they could to respond to incidents involving the woman, and the last time she caused any problems was a full two weeks before the bureau’s unannounced visit.

Holloway also said the agency is overreacting to political agendas raised by concerns at other, poorly run nursing homes. His center is being unfairly punished, he said.

“I think it’s pretty ridiculous that we were cited on such a high level,” he said.

The resident apparently had a run of abusive behavior during the month of May and half of June, according to the bureau.

In May, LaCrosse catalogued 37 incidents of hitting, kicking, biting and slapping. The resident was noted 29 times for verbal outbursts toward others, including shaking her finger at them.

On May 27, the woman came out of her room and pushed another resident down, which resulted in a 4-inch-long laceration to the back of the second resident’s head. The injury required a trip to the hospital and stitches.

The bureau gave several reasons for the punishment it levied:

LaCrosse failed to report each altercation.

When the altercations happened, LaCrosse didn’t consistently and properly intervene.

Afterward, LaCrosse didn’t adequately update the woman’s care plan and medication levels.

By doing so, the report alleged, LaCrosse was endangering at least 10 other residents of the ward.

Holloway said the nursing home reports any altercation that is willful and results in an injury. The laceration, for example, was reported.

But in December 1999, the state changed its rules to say every altercation must be reported. Holloway insists he wasn’t aware of the change.

And every altercation isn’t abuse, Holloway said. Some of the incidents the bureau said should have been reported were no big deal, he said.

Some behavior was labeled “overt sexual passes,” for example. “The resident was kissing and patting below his waist line …” In reality, Holloway said, the resident had patted a gentleman on the knee and kissed him on the cheek. He balked at the idea of being fined for not reporting incidents like that.

As for the failure to properly intervene, Holloway said his staff members instantly responded to each altercation. All residents are supervised 24 hours a day, and when fights broke out, the participants were dealt with, he said.

The inspectors’ report claims the way patients are dealt with doesn’t suffice, however. After the day of the 4-inch cut, the report says, the state ordered that the 87-year-old woman was to be checked on every 15 minutes, and supervised one-on-one. After reviewing the care plan, inspectors found that did not happen.

Also on that day, a LaCrosse report said staff would try putting a stop sign on the front of the woman’s door to keep wandering residents from entering her room. The inspectors’ report said that didn’t happen, either.

The woman, whom Holloway described as a “sweet old lady,” was admitted to LaCrosse in November with Alzheimer’s, cancer and depression.

Most of the time, she hasn’t bothered anybody, Holloway said. But occasionally, people with Alzheimer’s suffer from periods of high aggression. That was true in this case, he said, but since mid-July, the woman hasn’t harmed anyone. Scuffles are a natural part of running an Alzheimer’s ward, Holloway said.

“You’ve got 20 residents in a locked unit. If you’re living with the same 20 people, you’re bound to have angry words at somebody,” Holloway said. “These people are demented. They may think they’re yelling at one of their kids.”

Recording every altercation between residents would swamp LaCrosse’s staff, he said. That time should be spent with the patients, he said.

Ransom said most facilities in the state comply with their regulations. Though there have been other fines, they aren’t common.

This is the first time LaCrosse has been recommended for a fine. The Health Care Financing Administration will decide whether the fine will stick.

Holloway said LaCrosse is appealing the penalty.