‘It hurt so bad:’ Multiple acts of abuse alleged at Iowa nursing home

An Iowa nursing home where a resident was repeatedly slapped, and where workers reportedly borrowed money from a resident, poured water on his head and called another resident a “wimp” after she cried out in pain, is currently facing a $6,750 fine from the state.

Last week, the Iowa Department of Inspections and Appeals issued an inspection report detailing resident abuse at the Ruthven Community Care Center in northwest Iowa. To date, no fines have been imposed for any of the abuse-related issues, which are considered federal violations, but DIA has fined the home $6,750 for the separate, state violation of failing to maintain residents’ nutritional status.

In one incident reported by DIA inspectors, a worker 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.”

In a separate incident, inspectors noted that a male resident complained that a nurse aide had asked to borrow $40 from him because she was broke. The man told inspectors he loaned her the money and that he was never repaid.

The director of nursing told inspectors the facility did not conduct an investigation into the matter, although at least two workers were aware of the man’s complaint. “I thought everyone knew so I didn’t report it,” one worker reportedly told an inspector.

The same resident who said he loaned the money to a worker reported 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.”

In an interview with inspectors, the home’s director of nursing acknowledged she was aware of the matter but didn’t investigate it, saying the resident “likes to joke. His personality changes. One minute he will joke with the girls, and the next he doesn’t like it. I didn’t take it further than that.” 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.

Inspectors also reported that last September, a nurse heard a female resident yelling and saw a male resident holding the female’s wrists. The two were separated, but later that day, a nurse heard the female resident scream again. An aide reported the male resident had grabbed hold of the woman’s wrists, at which point the woman stepped back and “open handedly smacked (the man) 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 reported other incidents, inspectors said, such as an occasion when the female resident threatened the male resident with a rolled-up newspaper and two instances in which she had slapped the man.

‘Abuse’ cited as another type of violation

While DIA did not cite the home for any acts of resident abuse, the agency did cite the home for other violations related to the alleged abuse, such as failing to respect residents’ rights, failing to keep the environment free of accident hazards, and failing to follow policies regarding allegations of abuse.

The decision to cite a home for peripheral issues related to resident abuse — as opposed to abuse itself — can result in fewer sanctions against a care facility. In late 2019, for example, the federal government began flagging on its consumer-oriented nursing home website, now called Care Compare, those nursing homes that had been cited specifically for abuse and exploitation with a red “alert” icon. Those same facilities had their inspection-result ratings capped at two stars out of a possible five stars.

However, the consumer advocacy group called the Center for Medicare Advocacy has reported that violations indicating “the existence of abuse or potential abuse” may be cited by some state inspection agencies as other types of related violations, resulting in the alert icon never appearing alongside a facility’s name on the Care Compare site, despite documented findings of abuse.

The alert icon is not currently attached to the Ruthven Community Care Center’s name on the federal Care Compare website. The lack of an alert icon is to be expected given the specific violations cited by DIA last week.

Care Compare also indicates the Ruthven home was last inspected in February 2020, although inspectors have been there four times since then. Three of those visits were inspections geared toward infection-control issues, with one of them resulting in three regulatory violations being cited.

Worker falsified record of resident’s weight

Although state and federal records indicate no fines have been imposed against the Ruthven home for any of the abuse-related issues reported by inspectors last week, DIA did fine the facility $6,750 for a separate matter: failing to maintain residents’ nutritional status.

Inspectors say the home’s records show that a female resident lost 37 pounds, or 24% of her total weight, in just 11 days. It was later determined that the resident had lost that weight over a period of two months, during which time a worker had repeatedly copied down the resident’s previously documented weight without actually checking it.

The home’s dietician told inspectors that had the woman’s weight loss been reported as it dropped, she would have recommended interventions, but by the time she became aware of the situation, the resident had been admitted to hospice for end-of-life care and was hardly eating.

The administrator of the Ruthven home, Scott Kessler of Estherville, declined to comment on the inspectors’ findings when contacted Monday.