Nursing Homes Can Be More Problem Than Solution

Behind the official record of Corbin Convalescent Hospital are the troubled relatives of patients who must live the rest of their lives in a nursing home.

Putting an aging relative into even a good nursing home is an emotionally wrenching experience. But when the nursing home turns out to be a bad one, the problems multiply.

Families find their options are limited. They may be appalled by conditions at one nursing home, only to find it is impossible to find an empty bed at another.

They also may encounter a regulatory system that traditionally has been so secretive that a nursing home can be cited for endangering a resident’s life without the family’s knowing. Second of two parts. Many of the frustrations are illustrated by the experience of Alan Kramer of Sherman Oaks. He put his wife, Rosalie, in Corbin during the period when the Reseda nursing home was compiling a long list of health violations, leading to criminal charges against two of the home’s owners last summer.

Alzheimer’s Disease

Kramer had kept his wife at home as long as possible after doctors diagnosed her as suffering from Alzheimer’s disease, a fatal degenerative brain disorder. He vowed to make her last years happy ones.

He kept her lips red, her face powdered and her hair blond even as she became more of a child than an adult. He held her limp body and pretended they were dancing. He sang and pointed to the flowers on car rides.

Only when she stopped recognizing him did Kramer start looking for a nursing home.

Most nursing homes are full or almost full, and it can be difficult to find a bed. But Kramer had fewer problems than other people because he could pay for his wife’s care. She thus was more desirable to nursing homes than the 70% of the home residents in California who are on Medi-Cal. Private patients can pay up to $100 a day, while Medi-Cal pays a maximum of $42 per day in Los Angeles, regardless of how sick the patient is.

Corbin was not the first nursing home in which Kramer placed his wife. At another home, he said, a private nurse he hired to stay with her--at a cost of $270 a day-- threatened to quit because of rats and cockroaches. Kramer moved his wife.

He ended up taking her out of Corbin, too, and later settling a lawsuit against the facility, which he alleged had neglected his wife during her 10-month stay. The suit said she lost 70 pounds and had bruises on her body. The nursing home staff, Kramer said, told him his wife was striking herself.

Kramer said his visits with his wife were numbing. “When I left, I’d pass red lights and stop signs. When I got home, I never knew how I got there,” he said.

The allegation of neglect has been common at Corbin in recent years. Culminating four years of critical inspections, the county Department of Health Services tried to close the 157-bed home last summer. A Superior Court judge ruled, however, that the county had to inspect Corbin again. This time, the nursing home passed.

Because of the pending criminal case, Corbin executives will not discuss their facility. In the past, however, they have maintained that Corbin is providing excellent care.

Their attorneys say Corbin has become a scapegoat for nursing home regulators who are trying to appease consumer groups and others who want to make an issue of nursing home conditions. They contend that inspectors have been biased against the home, producing reports that make Corbin look worse than it is.

If they know where to look, families searching for a nursing home in the San Fernando Valley can learn what health department inspectors have said about Corbin and other homes. But the inspection reports, kept in orange folders at the county health services department downtown at 313 N. Figueroa St., are not popular reading.

Although someone drops in to examine a file about once a day, many are not hunting for a nursing home, health officials say. The readers are just as likely to be attorneys, prospective nursing home buyers or employers who wants to check the track record of nurses or others they are thinking of hiring.

Medical Jargon

Incidents in the reports are couched in sterile medical jargon, and nursing home residents are referred to only by an assigned alphabet letter.

One of the reports on Corbin described what happened to Kramer’s wife during her stay there in 1981 and 1982. Kramer said the citation came about by chance.

All along, Kramer said, the staff had been telling him that his wife’s bruises were self-inflicted. One night, however, she broke her nose and a nurse confided to Kramer’s daughter that she had fallen out of bed.

The next day, Kramer said, he burst into the administrator’s office demanding an explanation. A man sitting in the room overheard his complaint, Kramer said, and whispered to him, “Stick around. I’m from the health department.”

The inspector later issued a citation against the home for failing to properly restrain the woman. She had fallen five times, the citation said. Kramer filed his lawsuit soon after, settling it for undisclosed monetary damages.

Relatives of others who have stayed in Corbin since 1980--when it was taken over by Summit Care Corp. and Summit Health Ltd., part of a health care conglomerate that is the 12th largest nursing home provider in the country--have complained of different forms of neglect: baths skipped, patients unfed, dirty sheets ignored and immobile patients left unturned. One visitor recalled encountering orange road cones placed around urine puddles in the hallway.

“You have a headache at 9 in the morning; you would be lucky to get aspirin by 3 p.m.” said Arleen Friedlander, a middle-aged diabetic paraplegic who lived at Corbin for three months until September, 1983, when she was rushed to UCLA Medical Center.

Patient Files Suit

She also filed suit, contending she wound up in the hospital because aides ignored her request for a doctor or nurse to examine her numb feet. They were bloody and almost gangrenous by the time she reached the hospital, she said.

Corbin’s defenders say the home has been unfairly maligned, in part because of its policy of accepting residents that others snub.

Dr. Gilbert Solomon, a Reseda physician, said Corbin could be counted on to admit people who require extra care and therefore cause more problems. Solomon said that he has had 40 to 50 patients in nursing homes during the past five years and that those at Corbin “have been well taken care of.”

Corbin’s supporters also blame Carol Brotman, president of Families for Quality Care in Nursing Homes, a Valley-based advocacy group for nursing home residents, for stirring up bad publicity the Reseda home does not deserve.

Brotman, who received an award for her work from the mayor in November, said she founded the group, in part, because of her mother’s experience as a patient at Corbin. Her mother is in another nursing home now, but Brotman keeps one memento of Corbin--her mother’s cockroach-infested radio. The radio, which she took to a state hearing on nursing homes in Sacramento, was brand new when she took it to Corbin, she said.

According to court records, six lawsuits have been filed against Corbin since Summit took over its operation in 1980, including three last year.

Left Helpless

One of the plaintiffs is Lila Grimaila, a Northridge real estate broker, whose complaints stemmed from the treatment of her husband, Al, an electrical engineer and a former president of two corporations.

Several years ago, he was stricken by a disease that left him helpless. His intellect apparently was spared, she said, but the middle-aged man could not even lift an eyebrow or move a finger to let her know for sure.

Al Grimaila was at Corbin for three months, until Jan. 31, 1984. He left on a stretcher, sent to a hospital because the nursing home’s care caused advanced bedsores, the suit alleged.

In addition, Grimaila said, aides would leave her husband’s food tray on a table when they knew he could not feed himself. Often they did not shave him or brush his teeth or cut his hair, which grew to his shoulders, she said. His wedding ring was stolen, she said, as were many of his other possessions.

Robert J. Gerst, an attorney for Corbin, said Lila Grimaila’s suit is unfounded because her husband’s health problems, including his bedsores, were merely a further deterioration of his condition. Gerst said he has letters from physicians that will exonerate Corbin.

Gerst said all health institutions occasionally are sued and he called Corbin’s record better than many facilities. The Kramer case, he noted, was settled without Corbin’s admitting any negligence.

Lawyers who represent nursing home residents and those who represent the facilities give far different interpretations of who has the advantage in court.

Consumer advocate attorneys say the residents’ cases can be hard to prove because of the feebleness of the key witnesses. It is also hard to get attorneys interested because damages probably will not be high, they say. In a wrongful death case, for instance, the awards are partly based upon the victim’s projected earnings if he had lived--and nursing home residents are not breadwinners.

But Patric Hooper, an attorney with Weissburg and Aronson, which represents Corbin and other nursing homes, said that nursing home residents and their families hold the upper hand when cases do get to court because they can present such poignant stories.

“The situation has been so politicized, plus judges tend to have preconceived notions,” he said “It’s very difficult for a nursing home to get a fair shake.”

Robert Dawson, one of Hooper’s colleagues, recalled that at a coroner’s inquest involving a nursing home patient, the bailiff told him later that the jury spent an hour discussing a CBS series that portrayed nursing homes as warehouses of neglect. “This is what you’re up against,” he said. The nursing home, however, was exonerated.

There are other ways families can try to change what happens inside a nursing home. But consumer advocates say the remedies offered by the state and county are too little and underpublicized.

Merely understanding where to turn can be confusing. The state Department of Health Services’ division of licensing and certification regulates nursing homes in California, but in Los Angeles the county is under contract to provide the inspection services through its health facilities division.

The state Department of Aging also operates an ombudsman program for patients and their families. There are five ombudsman offices scattered throughout the city and county.

Families who have filed complaints with the county health department have found the experience frustrating at times.

Until recently, health investigators could not use eyewitness accounts of abuse to write citations against a nursing home unless investigators could substantiate evidence on their own. Without independent verification, such as nursing home records confirming the allegation, said Victor Arkin, program manager for long-term care in the county health department, investigators would “pretty much discount and ignore the statement of others.”

Even now, when eyewitness reports are used more, justice is difficult.

Report of Sexual Assault

In the fall, the county health department investigated a report that a female nurse sexually assaulted two elderly bedridden women who were roommates in a Valley nursing home.

After its investigation, the health department was convinced the patients were telling the truth and forwarded the case to the district attorney’s office, Arkin said. He said he got a letter back from a prosecutor, who said that he believed the nurse was guilty but that there would be no case because the testimony of feeble old women would not hold up in court.

In that situation, though, a complaint advanced farther than it often does. Frequently, according to Julie Bronson, a Los Angeles County long-term care ombudsman, “People in the facilities are either unable or unwilling to speak up.”

For families and patients, conditions at the current nursing home might be bad, but fear of the unknown is worse. If they leave or are evicted, they may find a new problem. In Los Angeles, the occupancy rate at long-term skilled facilities--nursing homes that can handle people with severe medical problems--is roughly 98%. The scarcity of empty beds discourages mobility.

Jere Stone received a rude lesson when he tried to place his elderly mother, whose leg had been amputated, in a nursing home. Corbin accepted Meta Stone, the only woman in her Columbia University class and a founder of the PTA.

“This was the only place we could find in the San Fernando Valley that had a bed that would take her,” Stone said.

When he tried to move her later because he was unhappy with conditions there, he called every nursing home in the phone book and solicited help from friends in the nursing home field without success. She stayed at Corbin for two years and died in December, 1982.

Despite the deterrents to complaining, the ombudsmen are not lonely. Bronson estimates that her office, which is supposed to keep tabs on residents at 260 skilled nursing homes in the county, receives between 50 and 75 complaints a month. Of those, 50% to 75% prove to be justified, she said.

Many of the complaints, she said, concern patient rights violations: A staff has physically or mentally abused a resident; someone has stolen a resident’s money or possession; or a resident might have been bathed in front of other residents or dressed in someone else’s clothes.

About 4% of the complaints are serious enough to be brought to the attention of county health inspectors, Bronson said.

What happens next is a process whose secrecy has infuriated relatives of some nursing home patients.

Lila Grimaila had no idea, for instance, that health investigators had issued an A citation to Corbin stemming from her husband’s condition until she read a newspaper account of the fining of Corbin for a series of health violations. An A citation is issued for conditions that pose an imminent danger of death or serious harm to a patient.

One of the violations described in the newspaper stemmed from her husband’s case. A health inspector saw Grimaila being fed through a nose tube while he was lying down. A patient must be sitting up during feedings or he could stop breathing.

When a nursing home contests such a citation, which can carry a fine up to $5,000, the health department holds a citation review conference. But generally, patients and their families have been barred from these conferences.

In a protest of the closed proceedings last February, Brotman, along with another member of her group, tried to sit in on such a conference dealing with Corbin. They were turned away.

But there has been some progress to open up the regulatory process to consumers.

Under a bill signed into law last year, effective Jan. 1 the nursing home resident or his representative and the ombudsman are allowed to attend the citation review conference. The family’s attorney also can attend if the nursing home brings an attorney.

Even before the new law went into effect, however, Lila Grimaila had attended a conference in Los Angeles under a little-known provision that allowed eyewitnesses to abuse to testify.

She told the health department that she had seen a patient at Valley Palms Convalescent Hospital, another Summit facility, writhing in pain and bleeding without receiving attention. She said testifying at the conference without an attorney to represent her turned out to be a degrading experience.

“They said I was housewife who had nothing better to do than play peekaboo” with a patient, she recalled.

The hearing officer ruled against Lila Grimaila, saying the patient was already in the hospital at the time she said she saw him. She admitted she could not remember exactly when the incident took place.

Although the citation review process has been opened, Gov. George Deukmejian vetoed most of the bills in a nursing home reform package passed during the past legislative session. A spokesman for the governor said some good proposals were tied to bad ones.

One of the bills vetoed would have allowed nursing home patients to seek retribution through small claims court, a less costly and less time-consuming procedure than is currently available.

Another would have extended the period in which a nursing home operator must hold a bed for a patient who has been sent to the hospital. A third would have established a new fine of up to $25,000 for nursing home abuse that results in death.

Some of those measures have been reintroduced for the current session.

Apathy Criticized

But ombudsman Bronson said meaningful improvements will not materialize until community apathy disappears. It is not enough, she said, for people to drop in on nursing homes at Christmas with fruit baskets and choirs. The invalids need other people’s eyes and ears there every day to notice problems when they occur, she said. Unfortunately, she said, “We can’t legislate that the community be involved.”

What officials of Corbin Convalescent Hospital would really like is to be left alone. Attorney Gerst said the facility is in good shape and plans to stay that way. But since it beat the county in court, he said, the health department has sent inspectors swarming over the institution.

“The department is overreacting to punish Summit,” he said. “It’s clear they are trying to pay them back.”

The day a reporter visited Corbin in November was a momentous one for Gerst and the home’s corporate owners. The health department announced that afternoon that the facility had passed its court-ordered reinspection and would get a license.

Chances are none of the residents knew what had happened, or cared. At 6:30 p.m., most of them were already in bed. Those still up were mostly the wheelchair set. One gregarious old woman immediately spotted a stranger and began speaking quickly. But none of her sounds formed words. She soon realized the futility of her efforts, or perhaps grew bored, and scooted away.

The noise from the televisions floated into the halls. Many of the rooms were awash in a blue haze from the sets. Corbin looked immaculate. Its walls were tastefully decorated with patterned wallpaper and pale orange trim and the floors were clean. The sickly medicinal smell that seems to hang in the air at most health facilities was faint. The nursing stations were staffed, and aides walked the halls and checked patients’ rooms.

The type of complaints patients had this day were the same type that might be heard at any health care institution. Their common complain was bad food. But two said stealing was a problem. One woman said all her clothes were stolen once, an experience that taught her to become “quite a bit craftier.”

Two woman said they wished more of the staff spoke English. Because much of the staff is Latino or Oriental, one said, life at Corbin “makes you feel like you’re in a foreign country.”

Many other patients could not talk. One woman nodded that she understood a visitor, but she seemed able to concentrate only on her pain. She thrust her hands, swaddled in bandages, up into the air and motioned for the visitor to tear the bandages off.

There are a lot of helpless people at Corbin. According to health department records, last June, 28 residents needed help eating, while 106 were incontinent.