Happy Endings

A couple of weeks ago I started to tell the story of the Hettinger nursing home, a story with a pretty happy ending. Here’s a little synopsis. Last September, the North Dakota Health Department responded to a complaint that an elderly resident had died, choking on some food during a meal. That led to an inspection which found multiple problems with care at the home. The home was not shut down, but was told they would not be allowed to admit any more residents until they cleared up their problems.

A Bismarck Tribune reporter got wind of it and did a long story, which ran at the top of page one. The reporter struggled between sensationalism and empathy. For the most part, empathy won out, but the result was a real black eye for the nursing home. And it scared the shit out of people who had relatives in the home. At least one actually moved out, to a different nursing home.

My mother had been a resident there from January 2005 until last September. When she moved there in 2005 she told her kids she wanted to live there because Hettinger was her home town and her friends were there. She told her kids she could do most things for herself, which was good, because there was almost always a pretty severe shortage of help. She said that when she was no longer able to do that, and required more intensive nursing care, she would probably move to a nursing home in Bismarck, where she would have access to better care. When that time came, last spring, she changed her mind, decided she wanted to stay there. She was hopeful that the new owners, West River Health Services, the local nonprofit which took over from the for-profit corporation that had run the place into the ground, would increase the staffing, and she would be okay there. She remained there until she died in September of natural causes.

Staffing problems were chronic during the entire time my mother lived there. Nurses traveled from as far away as Devils Lake and Minot just to maintain minimal staff. The problem: there simply aren’t very many nurses living in Hettinger, or Mott, or Lemmon, or Bowman, or in any small town in North Dakota these days. Contract nurses from afar had to be brought in, at outrageous costs—if indeed any could be found. Likewise, there was a shortage of CNA’s to assist them. My mother told us often of staff working double and triple shifts just to make sure there was someone available to help the residents.

During my many trips there in the last nearly five years, I met many of the staff. They were caring and professional, friendly and helpful, but often under-trained in geriatric medicine, overworked, and probably underpaid. All were young enough to be my mother’s children, and she was like an adopted grandmother to many of the younger staff. They treated her as they would treat their own mother or grandmother. We were grateful for that.

Perhaps some mistakes were made. Perhaps the doctors and board members and staff who run West River were too ambitious in thinking that they could provide quality end-of-life care for the elderly in their community. Perhaps they should have given up, sent those old folks in need of skilled care off to Dickinson or Bismarck or Rapid City where there was adequate staff available. Instead, they tried to keep providing this service right there in their small town. I say, God bless them for that.

As my mother neared the end of her life, she was saddened by the problems the nursing home was experiencing. My mother was a nurse, and for much of her career was Director of Nursing at that very nursing home. She knew what it was like to have adequate and trained staff. Hettinger was a bigger town then, and there were enough nurses, and aides, as they called them then, to provide good quality care. And she could see how difficult it had become there to care for the residents with inadequate staff levels.

But she was overjoyed and optimistic when the new owners took over, because West River Health Services in Hettinger is one of the single greatest success stories of rural medicine in America. With more than a dozen doctors providing care for a rural geographic area about the size of Rhode Island, they just completed a multi-million dollar upgrade of their hospital, and there are dreams on the drawing board of replacing the nearly 50-year-old nursing home with a new facility. I hope they succeed. I hope they can find the staff. I hope people will move there and work there and enjoy the quality of life a small town can provide.

Here’s the recent good news. In December, the Health Department went back to the Hettinger nursing home and found out that the home had resolved all 31 of the citations for substandard care they had received in September. ALL 31! They have been given the green light to begin re-admitting new residents. I’m going to drive down there one of these days and thank the staff, especially Susie and Barb, again, for all they did for my mother. I know they had a rough fall. I know they kept on caring for their residents as they worked to correct the problems. The newspaper said West River Health Services had invested an additional $350,000 in staffing since the citations were issued. I don’t know how they did that, but good for them!

Still, this is a way bigger story than just the problems of one nursing home in rural North Dakota. It is the story of the depopulation of the prairie. There will probably be more like it. Because if no one with skilled nursing experience lives in rural North Dakota, there will come a day when there are no more small town nursing homes. And then small town residents will have to drive far to see their elderly parents, and they’ll see them weekly or monthly, instead of daily. That will be sad.

Postscript: I remain in awe of that bunch of medical professionals in Hettinger. I was just reading my Pheasants Forever magazine, a slick, glossy, full-color publication which comes monthly from that organization. It has a section that carries ads for hunting equipment, hunting dogs, hunting preserves, hunting vacations, and all things upland game hunting. Pheasant hunters all over the country read it and patronize those advertisers. And right in the middle of that section is an ad placed by West River Health Services of Hettinger, North Dakota: Physicians Wanted. If you’re a doctor and like to hunt, call us, and come out to Hettinger for a visit. Great place to live and raise a family and enjoy the outdoors. Jim Long, administrator at West River, tells me they got a couple of responses, but haven’t yet recruited a new doctor. But they hope to. And I bet they will.