The resident was admitted with multiple diagnoses including dementia, heart failure and diabetes. On July 31, a nursing progress note documented that his health care coordinator would be looking for a podiatrist referral for diabetic foot care.
By August 15, staff noted the resident needed a referral from his primary care provider to see the selected podiatrist for nail care, with forms waiting for processing and signature. A week later, on August 22, the physician assistant agreed the resident should be seen by a podiatrist.
Federal inspectors arrived at the facility on November 11 and observed the wound nurse changing dressings on the resident's right and left heels at 11:26 AM. His toenails were thick, yellowish in color, and misshapen or raised from the nail beds.
The resident's record showed he was finally scheduled to see podiatry the next day, November 12. That appointment came about 10 weeks after the physician assistant had agreed he needed foot care.
The wound nurse told inspectors the resident had dystrophic toenails that were thick, oddly shaped and colored yellow or brown. She said it was difficult for staff to cut his toenails and believed the podiatry request was for his toenails and consultation for a diabetic shoe.
She didn't know why the appointment took so long to schedule.
The health information manager said she believed she was informed of the resident's need for podiatry in September and asked the unit clerk to submit the necessary paperwork. But the hospital rejected it because they didn't have the resident's information on file.
Staff discovered that because the resident was a veteran, his care needed to be transferred from his previous provider to his current provider before he could be scheduled. The resident's representative needed to make this call to initiate the transfer.
Nobody knew about this procedure.
The health information manager said staff thought the resident could go to any hospital for treatment because he was a veteran. After the representative made the required call, she said the resident's paperwork was resent about three times and several phone calls were made to follow up on his podiatry appointment.
When asked if the resident could be referred to a private medical provider since he had other medical insurance, the health information manager said she called a podiatry clinic but was told there would be a copay. The resident's representative refused to pay it.
Other clinics wouldn't accept the resident's insurance.
The facility's CEO acknowledged the systemic problems during the inspection. She said many veteran families want their relatives seen at VA hospitals and don't want care outside the Veterans Affairs system.
"Unfortunately the hospital was having a staffing crisis and they can only see so many residents in general," the CEO told inspectors. "We were not aware of the need for the resident's care to be transferred from one hospital to another hospital."
The CEO said she had been trying to get a podiatry contract for over a year, but no providers were accepting it.
While administrators struggled with paperwork and insurance complications, the resident's condition deteriorated. Diabetic foot care is considered essential because diabetes can cause nerve damage and poor blood circulation in the feet, making patients vulnerable to infections that can lead to serious complications.
The facility's failure to ensure timely podiatry care created the potential for the resident to experience ongoing thickening of his toenails or other complications, according to the inspection report.
Federal inspectors found the facility failed to provide appropriate foot care as required by nursing home regulations. The violation was classified as causing minimal harm or potential for actual harm.
The resident finally received his long-delayed podiatry appointment the day after inspectors documented his thick, misshapen toenails and the facility's 10-week struggle to coordinate his care.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Idaho State Veterans Home - Post Falls from 2025-11-11 including all violations, facility responses, and corrective action plans.
Additional Resources
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