Nursing home stay an eye-opener for advocate for elderly

  • Article by: BRAD SCHRADE , Star Tribune
  • Updated: July 26, 2011 - 11:26 AM

Advocate for elderly cuts short a "dehumanizing" visit in facility.

Deb Holtz chose outpatient physical therapy rather than stay in nursing home.

Photo: Tom Wallace, Star Tribune

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As the top consumer advocate for thousands of elderly Minnesotans, Deb Holtz hears daily from nursing home residents who have been wronged in some way. But it wasn't until she checked in for a week of post-surgical rehab at a Twin Cities facility recently that she fully realized how vulnerable anyone can feel when dependent on others for care.

Holtz, who cut her visit short after just 25 hours, said her experience makes her wonder how many vulnerable adults have suffered without telling anyone. She said the worst part occurred when a nurse began a routine skin check that seemed more like a strip search.

"I felt like I lost part of my dignity," said Holtz, 55, the state's Ombudsman for Long-Term Care. "I know it sounds completely irrational, but part of me didn't want to go to sleep that night because I didn't know who would come into my room and do any more checks. It was very dehumanizing."

Of the 2,500 complaints that came into Holtz's office last year, 43 percent centered on patients' rights, often in situations that threaten someone's "dignity, respect, choice and privacy," according to the ombudsman's annual report. The office also receives complaints regarding abuse and maltreatment.

Among the patients' rights cases substantiated by state investigators: A nursing home resident who died after she was forced to move to a different room; a nurse who screamed and threw a fit in a patient's room; an in-home care attendant who had to be removed by police after showing up in an agitated state at a client's home; and a nursing home aide who posted a photo on Facebook of a resident lying in bed in a medical gown.

For Holtz, visiting a nursing home became necessary after complications from shoulder replacement surgery in late May left her unexpectedly without use of her right arm or hand. She picked Langton Place because she heard the Roseville nursing home was "one of the best in the state" and because her father had a good experience there last year. Holtz doesn't recall telling anyone at the facility about her oversight job with the state.

Within hours of entering Langton Place, things started to go wrong, Holtz said. Except for someone who came to offer dinner, Holtz sat "alone in my room for five hours, with no admission meeting, no greeting, just nothing."

Just before bedtime, a nurse entered the room and politely told Holtz she needed to undergo a skin check. Holtz said it's an important procedure intended to protect immobile residents from bed sores, which can be deadly.

Holtz told the nurse she was mobile and not at risk. But she said the nurse insisted on the check and started inspecting her feet and other exposed areas. Then she asked Holtz to pull down her sweat pants.

Holtz refused to cooperate. She told the nurse to write on her chart that the patient declined treatment, a move she knew she was legally entitled to make.

But the exchange made her wonder how those who don't have a firm grasp of their rights would handle such a situation.

"If it was that uncomfortable for me and that scary for me, I just kept thinking of the older people that come in and don't know that they have choices or are already confused and sad or probably depressed they are going there," Holtz said.

The next morning, Holtz was abruptly awakened when an aide turned on the room's bright lights. Holtz was told to stand up so she could be weighed.

"I thought again about the lack of remembering that this is a person," Holtz said. "I'm not just a check mark on your to-do list. Just even saying good morning, that would have been nice."

Later that morning, when a friend called to check on her, Holtz asked to be picked up and went home.

"It was a little scary because you are part of a larger system," Holtz said. "I didn't feel like I had control of my environment or possibly my body."

What happened to Holtz is atypical, said Natalie Morland, director of clinical services for Presbyterian Homes and Services, which operates Langton Place and 34 other care centers in Minnesota, Wisconsin and Iowa.

Morland said Holtz checked in during a shift change at the transitional care unit, which sometimes gets a rush of admissions. "We regret anyone would have that kind of negative experience," Morland said. "We will do our best to do better."

Morland said the company takes feedback "very seriously" and will improve training and systems to avoid a repeat occurrence.

Holtz credited the facility with being responsive to her concerns. She plans to start a dialogue with the nursing home industry about patients' rights and dignity issues. She also wants more interaction from her office with residents, through brochures and increased volunteer outreach.

Brad Schrade • 612-673-4777

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