DES MOINES, Iowa. (Iowa Capital Dispatch) — State officials say they were justified in not citing a Ruthven nursing home for abuse last month and have yet to make a criminal referral in the case.
Two weeks ago, the Iowa Department of Inspections and Appeals (DIA) issued an inspection report detailing allegations of resident abuse at the Ruthven Community Care Center in northwest Iowa.
The home is currently facing a $6,750 fine from the state. However, that fine is not tied to any of the abuse-related issues at the home. The state fine is for a separate violation alleging a failure to maintain residents’ nutritional status.
The Iowa Capital Dispatch asked a department spokesperson whether the agency had referred to prosecutors an inspector’s findings that a nurse aide had borrowed $40 from a resident and then never repaid the man.
In response, DIA spokesperson Stefanie Bond said, “it is the facility’s responsibility to report suspicion of crimes to law enforcement,” but added that DIA intends to make a referral, as well, once the matter is reviewed.
She said the DIA nursing home inspector consulted with the agency’s Abuse Coordinating Unit, and the unit is currently “reviewing this allegation for abuse.” Once that review is completed, she said, the unit “will make a referral to the local county attorney and DIA’s Medicaid Fraud Control Unit.”
Bond also defended DIA’s decision not to cite the loan or other incidents at the home as actual abuse, preferring instead to issue citations for peripheral violations such as failure to respect residents’ rights or dignity, or failure to develop or follow policies related to abuse.
For example, the same resident who said he loaned money to one of his caregivers told inspectors that at one point the “kitchen staff poured water on my head.” The man, who has cerebral palsy, explained that he believed the act was intended as a joke, but believed it was inappropriate.
“I’m very jumpy and used to have seizures,” the man told inspectors. “She would poke my ribs, too. I asked her to stop, but she didn’t. I moved places so she couldn’t do it so easily … The kitchen staff tell me they are joking and having fun, but it feels like they’re picking on me. I reported it but as far as I know, nothing was done.”
The home’s dietary supervisor told inspectors she had poured just two drops of water onto the resident’s head, and then wiped it off.
Asked why DIA hadn’t cited the incident as abuse, and instead categorized it as a failure to develop policies that pertain to abuse allegations, Bond said only that the violation DIA chose covers policies related to “screening, training, prevention, identification, investigation, protection and reporting/response. The deficiency would be appropriately cited in this category for the facility’s failure to implement any of those seven areas.”
In another incident reported by a DIA inspector, a worker at the Ruthven attempted to change the wound dressing on a female resident’s leg by raising the woman’s leg off the bed while the resident was using a bed pan, causing the woman to cry out in pain. According to another employee, the worker responded to the resident’s protests by telling her, “Stop whining. I have a job to do.”
The resident later told inspectors, “It hurt so bad. I told her that I could lift my leg, then she just dropped it and told me to stop being a wimp.”
Asked why DIA categorized that incident not as abuse but a failure to respect residents’ rights and dignity, Bond said the situation could have been cited as either, but the same enforcement action would apply.
When asked about the federal government’s consumer-oriented website, which flags those nursing homes that are cited by inspectors for abuse, Bond said the website does so only in cases of “actual harm” and in cases of repeated acts cited as abuse — neither of which would apply to the case at hand, she added.
Last year, DIA inspectors reported that staff at the Ruthven home saw a female resident strike a male resident in the face. A few weeks later, there was another incident in which the two residents had to be separated after the woman reportedly grabbed the man by the neck. Staff then told inspectors of other incidents, such as an occasion when the female resident threatened the male resident with a rolled-up newspaper and two instances in which the woman had slapped the man.
While DIA did not cite the home for acts of resident abuse, the agency did cite the home failing to respect residents’ rights, failing to keep the environment free of accident hazards, failing to follow policies regarding allegations of abuse and failing to maintain adequate nursing supervision.
Bond said the altercations occurred due to a lack of adequate nursing supervision at the home, and that by citing it as such, DIA required the home to write a plan of correction that directly addressed that lack of supervision.
The administrator of the Ruthven home, Scott Kessler of Estherville, has declined to comment on the inspectors’ findings.
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