By David Grant Long

Several deficiencies were uncovered at Vista Grande Nursing Home in Cortez during an inspection by the Colorado Department of Health and Human Services in September, according to a report obtained by The Cortez Journal, the most common involving patient hygiene.

"Based on observations, record review, resident, family and staff interviews," the report said, "it was determined that the facility failed to provide incontinence/toileting and grooming services for four of 15 sample patients.

"Joanne Aldrich, director of the home, downplayed these deficiencies Friday as being a one-time aberration and pointed out that previous inspections generally have been much better. "We had four incidents that one day (Sept. 16) the state was in here," Aldrich said, "but that’s not a routine happening here. It was an isolated incident -- everyone has bad days.

"We’ve corrected any and all problems and are waiting for the surveyors to return," she added. (Facilities where deficiencies are found are given 30 days to rectify them and are then re-inspected.) The deficiency considered the most serious, however, involved a 93-year-old woman who repeatedly received cuts on her legs from unpadded metal protrusions on her wheelchair over a four-month period, according to the report, although that finding is being disputed.

"The rehabilitation director stated that there was a controversy around whether to pad the wheelchair or to provide the resident with leg protectors," the report said. "The facility failed to provide timely intervention," it added, which "resulted in new skin tears that caused discomfort to the resident as well as the need for specialized wound-care treatment." Although she refused to discuss the specifics of the case, citing patient confidentiality, Aldrich said there were extenuating circumstances involved.

"We’re denying those allegations," Aldrich said. "That is in informal dispute resolution with the state of Colorado." And the other deficiencies have been addressed, she added.

Other unacceptable conditions cited in the report include incontinent, paraplegic patients sitting or lying in their own waste for seven hours or more, and another resident who was receiving a blood-thinning medication not getting blood tests for months on end despite a doctor’s order they be performed every two weeks.

Aldrich also explained that a study conducted by the Colorado Department of Health-care Policy and Finance found that Vista Grande’s acuity rate, or the severity of illness among patients, is the third highest in the state, which makes addressing their needs a much more formidable task.

"We have a very challenging group of people to care for," she said. Moreover, Aldrich added, when the federal government is surveying the state inspectors, as was being done in this case, "the survey becomes more stringent than is typical, and when you have a high acuity rate, that’s what makes the difference."

The nursing home, owned by the Montezuma County Hospital District, was leased to Greeley-based Continuum, Inc. five years ago to be run as a for-profit business. Continuum pays approximately $160,000 to the district annually under the lease arrangement, which was approved by the district’s board of directors after Steve Selzer, former CEO of Southwest Memorial Hospital, convinced them the home could not be operated profitably by the hospital.

At the time, critics of the arrangement voiced fears that turning the nursing home into a profit-making operation would lead to a deterioration of patient care. They also argued that if a private company could operate the nursing home at a profit, there was no good reason why more efficient management by Quorum, the hospital district’s management company for whom Selzer worked, couldn’t achieve the same end.

The lease is presently being re-negotiated, with Continuum demanding a 40-year lease with an option to sell all or a portion of it to another for-profit company -- or to sell the lease back to the hospital district, which would have the right of first refusal, if it were willing to pay the market price.

Other violations found during the inspection included malfunctioning dishwashing equipment that wasn’t sanitizing the dishes; a failure to provide patients with wheelchair support and prosthetic devices to help them function better; and a failure to provide privacy for a resident while the lower half of her body was exposed for examination of bed sores.