Senator Grassley Calls for Investigation of Nursing Home

January 27, 2008 

By CLARK KAUFFMAN
DES MOINES REGISTER STAFF WRITER

U.S. Sen. Charles Grassley is calling for a federal investigation into the way Iowa and other states respond to complaints of poor nursing home care.

"I have an obligation to protect Iowans, and all Americans, from substandard nursing care," the Republican senator from Iowa said in a letter Thursday to federal officials. Grassley criticized Iowa's nursing home inspectors for failing to thoroughly investigate a complaint involving Waterloo's Ravenwood Nursing and Rehabilitation Center.

In August 2006, Maizie Bickley was an 89-year-old resident at Ravenwood. Nurse aide Connie Rust called Bickley's daughter, Sandra Bickley, one night to report concerns that Maizie Bickley was very ill and wasn't being properly evaluated or treated by the nurses.

Sandra Bickley insisted that the home call an ambulance to transport her mother to a nearby hospital. Medical records show that within hours of Maizie Bickley's arrival there, she was diagnosed with a possible bowel obstruction, an infection, and dehydration. Two days later, she underwent surgery for a potentially life-threatening condition.

The owners of Ravenwood, Care Initiatives of West Des Moines, fired Rust, citing a company policy that prohibits conduct " that results in serious negative public relations."

Sandra Bickley was furious, particularly when the Iowa Department of Inspections and Appeals looked into Ravenwood's care for her mother and found no problems. She complained to Iowa Citizens' Aide Ombudsman William Angrick and Grassley.

Around that same time, Dean Lerner, who now heads the state inspections department, asked the federal Centers for Medicaid and Medicare Services to do its own review of his agency's work on the case.

That federal review concluded that state inspectors didn't conduct a thorough investigation of the Bickley case and didn't interview nurses, ambulance workers, or the hospital's emergency room staff.

"I'm not satisfied with the investigation we did," Lerner said Saturday. He said that although his department's investigators interviewed Ravenwood residents, reviewed records, and made their own on-site observations, more should have been done.

An attorney for Care Initiatives has said that federal law prohibits the company from commenting specifically on the Bickley case.

Grassley is now asking the Government Accountability Office, which is the investigative arm of Congress, to examine the nation's state-run nursing home inspection agencies and the manner in which they respond to complaints.

He is also asking the Centers for Medicaid and Medicare Services to give him four years' worth of investigative reports dealing with state inspections in Midwestern states such as Iowa and Nebraska. He said he wants to know whether the Bickley case is an anomaly or an indicator of a more widespread problem.

"Unfortunately, the Iowa Department of Inspections and Appeals investigation appears to have been wholly inadequate," Grassley said.

Lerner said his department will cooperate fully with the federal agencies. Lerner said that he understands Grassley's concern, but added that "the Department of Inspections and Appeals, under this current administration, doesn't take a back seat to anyone when it comes to protecting the health, safety, and welfare of the elderly."

Although certified nurse aides have relatively little training compared with registered nurses, it's the aides who provide most of the hands-on care in nursing homes. But they typically are prohibited from sharing concerns about the quality of care with residents' family members. They're supposed to relay any concerns to administrators or licensed nurses.

In the Bickley case, Rust's complaint was that the nurses weren't responsive. She could have called the inspections department's hotline, but it was after 1 a.m. and she would have received an answering machine. She eventually called Sandra Bickley at home to suggest Bickley get her mother to the hospital and then look for another care facility.

At a public hearing dealing with Rust's claim for unemployment benefits, one Ravenwood nurse admitted that Maizie Bickley needed to be taken to the hospital's emergency room that night, but said at the time she hadn't thought it was necessary.

The judge, in that case, denied Rust unemployment benefits, saying she had made "highly inflammatory remarks" that "could result in legal liability for the home."

Maizie Bickley is now living at the Manor Care home in Waterloo. Sandra Bickley said she is satisfied with that home and the staff's efforts to care for her mother.

"But the problems with nursing homes are widespread," she said. "We're basically just warehousing our senior citizens in this country. Too many homes are owned by corporations, and for them the bottom line is profit."