Ackley, Iowa – In February, a resident with dementia at the nursing home here wandered outside in the frigid cold in a nightgown, fell face down in the snow and wasn't found for at least two hours.
The same month, an Alzheimer's patient sexually assaulted another patient who couldn't recollect what happened, state records show.
In March, the state issued a maximum $10,000 fine because of the seriousness of both incidents.
By summer, the board of the 78-year-old home renamed it — from Presbyterian Village to the more swanky Grand JiVante? — and announced plans for a significant expansion in nearby Iowa Falls.
That flurry of revelations at Grand JiVante?, Ackley's largest employer, has rankled many in the town of 1,500.
They question why an expansion is necessary since Hardin County has steadily lost population, and not a single home in the area has been full, according to the state. And Iowa Falls already has two nursing homes — Heritage Care Center and Scenic Manor — that currently rate higher than the Ackley home in terms of care, according to federal report cards.
A group opposing the expansion has started a petition, signed by 150 residents, and solicited letters to board members from local medical professionals.
Julie Hinders, administrator of the home, has indicated in press releases that the home wants to offer a new, more independent model of care that currently doesn't exist in that part of central Iowa.
Plans call for a neighborhood-like campus south of Iowa Falls full of cottages with amenities from a lap pool to gourmet food delivery to a hair salon and bar. It would sit conveniently near a new hospital and would employ about 50 to 75 more people.
But Hinders and the home's board haven't publicly said how they'll pay for such an ambitious project.
Local grocery store owner Nick Graham says he's been threatened with litigation for trying to ask Hinders where a private nonprofit and its foundation are going to get the money.
Hinders did not return my phone calls last week, nor did the home's chief financial officer.
Ken Porter, marketing director at Grand JiVante?, said he couldn't talk about the staffing and care issues and said only the chief financial officer knew the financing details for the new expansion.
"In our industry, growth is key to survival," he said. "What we are doing (in Iowa Falls) has nothing to do with what we're doing here."
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On a recent day, I sat down with Graham and a group of other residents with questions. They allege the home has had high turnover of long-time employees in the last two years and cut staffing hours.
Nurse Roberta Meints, a board member until 2013 and former employee, alleges that wages for direct caregivers have remained stagnant, while administrators have received hefty raises. Laura Brunsen, a referring doctor to the home, wrote a letter saying Hinders' spending choices have directly affected patient care.
"It seems to me that the money they will be using to expand should be used to provide services at the current facility," Brunsen wrote in her letter.
State records show Grand JiVante? got its $10,000 fine reduced to $6,337 and paid the penalty in May.
But new inspection reports show the home was fined $3,500 at the end of August, largely for failing to keep adequate nursing staff.
A report issued by the Iowa Department of Inspections and Appeals showed a sampling of residents either had or were at risk of bed sores, and some weren't fed, moved or medicated as they should have been.
Grand JiVante?'s nonprofit tax return showed $2.9 million in net assets at the end of 2012. That same year, its private foundation spent $551,476 — far more than the $205,579 it took in.
Meanwhile, from 2010 to 2012, Hinders received a 48 percent pay increase — from $91,624 to $135,189, the returns show.
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So far, Grand JiVante? has not submitted what's called a certificate of need application so it can obtain a new license for the Iowa Falls project.
It will need one to provide skilled nursing home care if it is going to add more than the existing home's 70 beds.
Barbara Nervig of the Iowa Department of Health said when the home makes its application, it will have to meet several criteria for licensing. Generally, state officials are against creating new nursing home facilities, but officials also realize current buildings are aging, she said.
Among the criteria a five-member commission will consider: whether less costly, more efficient options are not already available, whether existing facilities are being used in an appropriate manner and whether patients will suffer "serious problems" in the absence of new facilities.
Before any decision is made, the commission will hold a public meeting at which citizens and competitors could speak.
Porter said others in town support the expansion. He said he'll release details about the project when they are concrete.
"You don't want to put out what I call if'n and supposen information," he said.
"I would like to believe the powers that be would not have done this on a whim," said Porter, who has worked there for the past three months. "There has to be the target market there or we wouldn't be doing it."
Lee Rood's Reader's Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Contact her at lrood@dmreg.com, 515-284-8549 on Twitter @leerood or at www .Facebook.com/readerswatchdog.