Highly rated Iowa nursing home cited for abuse, neglect and resident deaths Feds give home five-star rating despite findings of abuse and neglect

Clark Kauffman | The Des Moines Register

An 87-year-old woman was dehydrated, in severe pain and may not have had water for several days prior to her death at a north-central Iowa nursing home, according to state officials.

The Iowa Department of Inspections and Appeals recently proposed a $29,750 fine for the Timely Mission Nursing Home in Buffalo Center due to the Feb. 27 death of Virginia Olthoff. However, the state has not imposed that fine to allow the federal Centers for Medicare and Medicaid Services to take over the case. To date, no state or federal fine has been imposed.

Despite having been fined last year for the physical and verbal abuse of residents, Timely Mission currently has CMS’ highest possible ranking for quality of resident care — five stars — but the lowest possible ranking in terms of government-inspection results. It has an overall rating of two stars, which CMS labels "below average." Some of the agency's ratings have come under fire recently because they are based in part on unverified, self-reported data.

Toby Edelman of the Center for Medicare Advocacy says that historically there has been little correlation between the findings of the government's own inspectors and the five-star rating system. Nationally, CMS has frozen the ratings at pre-November 2017 levels while it works on a series of revisions to the system.

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Olthoff grew up in Buffalo Center and was married to Harold Olthoff, a farmer, for 59 years until his death in 2012. The couple raised three children. According to her family, Virginia enjoyed bowling and, before moving into Timely Mission, she was often seen riding her bicycle in Buffalo Center, visiting with friends and neighbors.

In 2002, at the age of 72, she moved into Timely Mission. In the days before her death, the staff later told inspectors, Olthoff was often in pain and was crying, moaning, screaming and bleating "like a sheep," with Tylenol used to treat her pain. According to one aide, a nurse “blew it off” when informed of Olthoff’s increasing pain.

In the early hours of Feb. 27, staffers noticed Olthoff’s eyes were sunken and dark, her feet were cold and blue, and they were unable to get a blood pressure reading or feel her pulse.

Two hours and 45 minutes later, the staff had Olthoff taken by ambulance to a local hospital. When state inspectors subsequently inquired about the delay, a registered nurse at the home allegedly responded by saying she didn’t think Olthoff was “that bad yet” and said the staff “had other things to do besides sit there and watch the clock go by.” The nurse allegedly acknowledged that Olthoff looked gaunt, like she was dying, and that she didn’t think Olthoff “would make it.”

The emergency room doctor at the hospital later told inspectors that laboratory tests indicated Olthoff probably hadn’t consumed any fluids for four to five days before she arrived at the hospital and might have had very limited fluids for a few weeks. The doctor indicated Olthoff was comatose on her arrival but was awake and alert after receiving one full liter of water. She was taken back to Timely Mission later that same day and died early in the afternoon.

Olthoff’s younger sister, 85-year-old Delores Griffin of Buffalo Center, said the staff at Timely Mission didn’t tell the family much about the manner in which her older sibling had died.

“They didn’t do much explaining at all,” she said. “They just said, ‘It happened and that’s the way it is.’ It’s really quite upsetting to think of how all of this happened.”

Olthoff's daughter, Pat Blank, said, “My brother Daryl and I had no idea until we read the Department of Inspections and Appeals report that our mother had not been eating and was drinking very little for possibly as long as two weeks. We are angry and very disappointed that no one from Timely Mission notified us of the situation and of her declining health until it was too late. We're heartbroken to think that our mother was likely in extreme pain for quite some time."

Timely Mission has been cited by the state for failing to adequately address the needs of Olthoff and another female resident who was found in dead, in bed, less than an hour before Olthoff died. The home has also been cited for failing to assess a resident who was diagnosed at a local hospital with infectious colitis, a painful inflammation of the colon.

Last September, the Centers for Medicare and Medicaid Services fined the facility $58,000 for resident abuse that allegedly took place at the home last summer. According to state inspection reports, staffers and residents at the home reported that one of the workers was verbally and physically abusing eight of the residents — cursing at them, using profanity and yanking their arms and legs.

Timely Mission is run by a tax-exempt nonprofit corporation headed by president Lorie Bierle and vice president Larry Weaver. The two did not return phone calls from the Des Moines Register last week and this week.

According to the Iowa Department of Inspections and Appeals, Timely Mission is currently operating without a full-time administrator.