Videotape of L.A. Nursing Home Shocks Panel

The Senate Aging Committee, told that 10% of Los Angeles County’s 389 nursing homes repeatedly jeopardize the health and safety of patients, was shown a graphic videotape Wednesday depicting bedridden residents, backs spotted with open sores as they lay in their own excrement.

“When I turn, it kills me, it hurts so bad,” one woman said in the videotape as a nurse shifted her to reveal discolored patches on her buttocks.

When the screening ended, the silence of the crowded hearing room was broken only by a quiet comment from panel Chairman John Heinz (R-Pa.): “Pretty rough stuff.”

Attempts to Educate Officials

The tape, which left the usually garrulous committee members temporarily speechless, is an attempt to educate judges and other officials who “don’t really see and know what’s going on” at the worst nursing homes, said Ralph Lopez, chief of the Los Angeles County health facilities division.

Nationwide, the quality of such care has improved substantially in the last 10 years, but more than a third of the 13,390 federally certified nursing homes violated at least one basic standard relating to medical and nursing services, according to a staff report Heinz released Wednesday.

Before showing the videotape, taken in Los Angeles by Leland Harris of the district attorney’s office while on a surprise inspection earlier this year, Lopez described other violations at the county’s facilities, which house 40,000 patients--about a third of California’s nursing home population.

Making Unannounced Visits

In one incident, Lopez said, an aide was “caught in the act of raping a 34-year-old female brain-impaired patient.” Another nursing home used a blind patient’s personal funds to order a $692 television set, which was placed in a storage closet and “soon disappeared,” he said.

Special teams of Los Angeles County investigators, making unannounced visits on evenings and weekends, will use compact, portable video cameras while checking the most serious complaints of abuses in county nursing homes, Lopez said.

The patients in the videotape shown Wednesday are now getting better treatment, Lopez said in an interview after the hearing, but the county will be conducting follow-up inspections at this particular facility.

“We’ve warehoused tens of thousands of our oldest, sickest citizens, and the federal government isn’t doing anything about it,” Heinz said. “We must act to strengthen inspections, enforce penalties and put the care of patients first.”

Preparing Legislation

Heinz is preparing legislation providing a stronger federal role in overseeing nursing homes, which receive about $12 billion a year in public funds.

The federal and state governments pay the bills of more than 1 million people in nursing homes under the Medicaid welfare program, called Medi-Cal in California. Medicare, the hospital and physician care program for those over 65, is largely restricted to coverage of acute ailments and does not pay for those receiving custodial nursing home care.

The current inspection system is basically “successful in ensuring appropriate care in a safe environment,” said Dr. William Roper, head of the Federal Health Care Financing Administration.

However, new rules are being prepared for rapid cancellation of Medicaid contracts with substandard facilities, said Roper, whose mother, a victim of Alzheimer’s disease, spent the last year of her life in a nursing home. On the subject of nursing home quality, he said: “I bring a personal interest.”

Closure Can Cause Harm

Last year, 238 nursing care facilities were barred from participating in Medicare and Medicaid.

But the termination of federal eligibility contracts can harm patients and their families, forcing them to seek beds elsewhere at a time when many nursing homes are operating at more than 90% of capacity, other witnesses indicated.

The federal government should first use steps short of termination, such as fines and civil court actions, said Conrad Thompson, director of the Washington state bureau of nursing home affairs.

Relatives of nursing home patients offered the committee harrowing accounts of trying to seek improved treatment for the helpless and bedridden.

Dorothy Doyle was told to “take your mother and get out” when she complained to a nursing home administrator in Atlanta about her mother’s dirty room and the flies in her food and on her face. “I began praying (that) God would let my mother die,” she said.

Witness Describes Suffering

Peggy Dowling, in a voice sometimes cracking with emotion, recalled that her grandmother, partially paralyzed with a stroke, was in a Napa, Calif., convalescent home, where the aides “would try to shovel the food in so fast she would quit eating after two bites.” Dowling and her mother worked out a schedule to visit the home and personally feed the grandmother.

Dowling said her grandmother died last year, two days after she had begun suffering severe stomach cramps. During the weekend, the nurses refused to call a doctor despite repeated pleas from Dowling’s mother.

The state investigated, ruled the facility guilty of a violation and called for a fine of $25,000.