Beulah Mae Jones-Bestman was level-headed. Her younger sister, Gloria Jones-Dykes, remembered how Bestman would talk her down when she was anxious.

“She’d say, ‘Gloria, listen. What is wrong with you? Do you see worry on my face?,’” Dykes said. “She said, ‘Until you see worry on my face, you have nothing to worry about.’”

But in spring 2017, Bestman — then 73 — fell and broke her ankle. After treatment at Crouse Hospital, she was discharged for rehab to Van Duyn Center for Rehabilitation and Nursing at 5075 W. Seneca Turnpike in Syracuse in May, according to medical bills. She never went home.

Bestman died that August. Dykes believes her sister’s final months were painful and humiliating, marked by neglect and unhygienic living conditions at the nursing home.

“I saw worry on my sister’s face at Van Duyn,” Dykes said. “It broke my heart.”

Dykes, who is 73 and lives in Baldwinsville, New York, is one of many family members and residents at Van Duyn who have raised concerns about the quality of care at the nursing home. Since Feb. 1, 2016, the New York State Department of Health has received more than 500 complaints about Van Duyn, more than twice the state average per bed.

Van Duyn had several high-profile incidents in 2018 alone, from a body that decomposed in a too-hot morgue to a heating malfunction that left residents in rooms as cold as 60 degrees, according to Syracuse.com.

In the past four years, NYSDOH and the Centers for Medicare and Medicaid Services (CMS) have cited the nursing home for violations including failure to protect residents against falls, failure to administer needed medications and unnecessary use of mood-altering drugs.

Dykes kept a journal of her conversations with nurses and administrators at Van Duyn. Bestman fell multiple times while at Van Duyn, and staff didn’t hear or attend to alarms meant to alert them if she tried to get up on her own, Dykes said. One of the falls, in May 2017, was so severe that Bestman was taken to the emergency room at Crouse, according to bills from Van Duyn.

In July 2017, just weeks before Bestman died, nurses called Dykes to say that Bestman had fallen out of her wheelchair but was not injured. Pictures of Bestman taken after the fall show what appear to be bruises on her eye and knee. Dykes attributed these marks to the fall.

Between February 2016 and January 2020, Van Duyn received 76 citations from the NYSDOH for quality of life, medical care and safety issues. It was cited five times within that period for significant medical errors, like failing to administer needed medications.

Edna (left) and daughter Mary Chappell Photo courtesy of Mary Chappell

Mary Chappell, the daughter of a deceased former Van Duyn resident, said her mother, Edna, was a victim of just such a medical error. Chappell asked The Daily Orange not to use her mother’s last name on her lawyer’s advice.

Chappell pointed to medical records showing Van Duyn failed for more than a month to provide Edna with the medication she had been prescribed to control her hypothyroidism.

When Edna was admitted to Van Duyn in July 2018 from St. Joseph’s Hospital, her discharge summary noted that she suffered from dementia and hypothyroidism, a condition in which the body doesn’t produce enough thyroid hormone, according to the Mayo Clinic. Edna had been prescribed levothyroxine for the condition, according to the discharge summary.

Untreated hypothyroidism can cause depression, nerve damage and heart problems, according to the Mayo Clinic.

But Edna’s medical notes from Van Duyn show the nursing home was aware of her hypothyroidism yet failed to provide needed medication until mid-August, when a lab exam showed her thyroid-stimulating hormone (TSH) levels had spiked. The spike indicated that her body wasn’t producing enough thyroid hormone.

Chappell said Van Duyn administrators said clinical personnel had missed the medication at intake and the person who made the error no longer worked at Van Duyn.

“It’s clear to me that Van Duyn is at fault and is negligent,” Chappell wrote in a complaint she filed with the nursing home Aug. 29. “Also in Van Duyn medication list it has her list of (diagnoses) that shows she has thyroid disease. I’m not sure why any health professional who had seen that would not (have) questioned where her thyroid meds were.”

Before she went into the nursing home, Edna had at times acted aggressively due to her dementia, Chappell said. But once she moved to Van Duyn, she became depressed and cried nearly every day.

Medical staff frequently described Edna in their notes as “weepy,” observing on one occasion that, “Resident sleeps most of shift, but when she is awake, she is tearful … staff tries to meet her needs and make her happy, but we have no idea why she is non-stop crying.”

“It’s just horrific, what she went through every day. She never had a good day,” Chappell said.  “One day, I went to visit her, and I said, ‘Let’s go outside.’ She loves to be outside in the summertime. She loves the heat. And we would just walk. And we were walking up and down, and she was just crying and crying, ‘I want to go home. I want to go home.’ It just kills you.”

Dykes and Chappell had the sense that their family members were being neglected. They described feeling desperate, frustrated and powerless to change anything.

Chappell submitted formal grievances with Van Duyn administration, and Dykes said she has discussed her concerns with administrators on multiple occasions. Both said their complaints were acknowledged and circumstances would sometimes improve, but the changes were often temporary and superficial.

“They’ll kind of pat you on the hand, and be like, ‘Oh, we’re going to look into that,’” Chappell said. “Or they’ll give you a generic answer: ‘Oh, we’ll get back to you.’ But it never happens.”

The families said administrators at Van Duyn have met with the Van Duyn Family Council to discuss concerns and potential improvements. The nursing home has also recently overhauled its administration.

In November 2018, Van Duyn hired Amy Mahoney to replace former administrator Pat Deptula, who was removed in the wake of the heating malfunction in March 2018, according to Syracuse.com.

“Some of the residents you mention have been with us for many, many years,” Mahoney said in a May 2019 email statement. “We understand (the families) want the best for their loved one and again we cannot thank them enough for trusting us year after year.”

Mahoney did not comment on the specific cases raised in this story or on questions regarding medical care, staffing and complaints. She did not immediately respond to a request for an updated comment.

Chappell and Dykes said they are tired of airing their grievances over and over without seeing the lasting changes they believe are necessary. They both think of other residents, who don’t have the family resources their loved ones did.

“My mother’s roommate … no one ever came to see her,” Chappell said. “It’s just the saddest thing. So sad. Unfortunately, there’s a lot of people up there that no one comes to see them. … You shouldn’t have to live your whole life and that be the end of your life up there.”

Chappell said she intends to keep fighting for change at Van Duyn, despite the personal costs.

“It’s really time consuming, but I think it’s worth it — if nothing else, to get the message out there that you can’t do this,” Chappell said.  “It’s not right. It’s not fair.”

Published on March 9, 2020 at 12:40 am

Contact Madeleine: mdavison@syr.edu