Families Fear Uprooting Kin as Home Closes

‘It’s like Golden Age got caught speeding, and all the other cars are still speeding by.’

Elaine Ayers describes her mother-in-law, Dora, as a tough old bird, an Arkansas hillbilly at heart. But at 86, the elderly woman is on the downside of life, her body plagued with acute pancreatitis, congenital heart problems and other ills of old age.

As her health has waned in recent years, Dora Ayers has lived for visits from Elaine and other relatives, who make a habit of dropping by twice a day at the Golden Age Leisure Gardens retirement home in Vista.

But that could change soon. The elderly woman, along with more than 100 other residents of the 176-bed skilled-nursing facility, must leave Golden Age by Sept. 7.

The home, facing more than $200,000 in fines for a series of health-care violations, has been stripped of its certification for state and federal health insurance, meaning it cannot honor Medicare or Medi-Cal benefits used by people like Ayers.

Now, with space in San Diego County nursing homes at a premium, Dora Ayers faces the prospect of being shuttled to a facility outside the region, far from her kin. Relatives of some patients fear they may have to place their loved ones in nursing homes as distant as Yuma, Ariz.

“We’re just horrified,” said Elaine Ayers, a Vista resident. “We know she’s got to be sent somewhere. If it’s out of the county, we’re sunk. I don’t know what we’d do. I imagine she’d go right downhill. She’d become a statistic. And that’s all it would mean.”

The Ayerses and relatives of other patients at Golden Age say they are perplexed that state and federal health officials have slapped the facility with fines and stripped it of certification. Many praise the home, situated in a spacious, modern building on Melrose Avenue north of California 78, as an exemplary facility with a caring staff and a clean environment.

But state and federal health authorities tell a different story.

After an intensive investigation of the home in June, investigators with the state Department of Health Services cited the facility for more than 30 infractions, ranging from improper record keeping to failure to provide adequate care for three patients who died in the home this year.

While they sympathize with relatives worried about moving their loved ones, health officials say their overriding concern is for the safety of patients at Golden Age.

“There are substantial deficiencies that are causing an imminent threat to the health and safety of patients,” said Ronald Currie, of the federal government’s Division of Health Standards and Quality. “The most important consideration is the best interests of the patient.”

Relatives may argue that their loved ones are being treated well, but patients without such guardians may not be as fortunate, Currie said. “There may be others in the facility not getting that sort of good attention,” he said.

Although many of the facility’s problems--among them toilets being left unflushed or soiled towels lying on bathroom floors--may seem minor, they constitute a “disturbing pattern of errors” that could put the health of residents “at risk,” Currie said.

Not so minor, officials say, were the three deaths.

Two patients at Golden Age died of malnutrition and dehydration. A third resident, whose relatives are suing the home, succumbed after choking on food. Authorities say the deaths were caused by the staff’s negligence.

But Marshall Horsman, chief administrator at Golden Age, said the nursing home has gotten a bum rap. Most of the infractions involved minor problems, such as the failure of the home’s staff to fill out required paper work, he said.

“Our dilemma is this: Should we spend more time caring for the patient or filling out the required paper work?” Horsman said. “We’ve gotten into trouble because we spent too much time at the bedside of patients and not filling out charts.”

Moreover, the deaths at the facility all happened despite the best efforts of Golden Age employees, he insisted. The two patients who died of dehydration were reluctant to take drink or food, Horsman said, although staff members worked hard to persuade them to do so. In addition, their relatives’ wishes were that no stronger measures be taken to save their lives.

Ruby L. Schneider was one of those, dying at the facility after a two-week stay sandwiched around four days the 64-year-old woman spent in Tri-City Hospital. Although her case was cited by state health officials in its case against Golden Age, Schneider’s daughter says the nursing home did nothing wrong.

“They were not responsible for her physical condition,” said Debbie Bojorquez, recalling how her mother “gave it up” after her father died in January.

“Since she died at the rest home, they got blamed,” Bojorquez said. “She wasn’t in there long enough for them to do anything that might have harmed her.”

Horsman said the May 31 death of Henry Cooper, an 89-year-old suffering from both Alzheimer’s and Parkinson’s diseases, also could not be prevented. Although the elderly man’s daughters contend in a lawsuit that he choked on a 4-inch-long chunk of meat, Horsman insists that Cooper was getting the soft diet he required. The lawsuit is pending.

Cooper often would create a wad of food in his mouth and probably choked on it, Horsman contends. After paramedics cleared Cooper’s windpipe, he was taken to Tri-City Hospital but died a few days later of complications.

Golden Age opened in 1962 and was for years a small, 35-bed operation. Problems began to crop up when the home expanded 18 months ago, both health officials and Horsman agree.

“That has a potential for problems whenever you grow rapidly,” said Horsman, a 24-year veteran of the nursing home industry who began work with Golden Age in February. “You’re taking in large numbers of dependent people. At the same time you’re developing staff and trying to train them.”

In the meantime, he said, hospitals have in recent years begun discharging elderly patients to nursing homes earlier--and in far worse condition. While it once was standard practice to leave a patient’s discharge date up to the attending physician, now such decisions are made for more cut-and-dried, financial reasons because of changes in the federal and state medical payment system, Horsman said.

State officials say they began investigating Golden Age intensively in June after they had received 16 complaints and issued four citations during the preceding 12 months.

A team of state health investigators monitored the home for two weeks, sometimes staying there for 12 hours at a time, according to Ernie Trujillo, licensing and certification district administrator for the state Department of Health Services.

They didn’t like what they found, issuing citations for the deaths, for patients with bedsores, and for the bookkeeping errors. When the report was forwarded to federal officials, they took immediate action, ordering the decertification of Golden Age’s health insurance benefits as of July 24. Residents were to be given 30 days from that date to find new accommodations.

Horsman and other Golden Age officials met with Currie and other federal regulators at the federal offices in San Francisco on July 16 and successfully argued that a new survey was in order.

The same state investigators spent four more days in Golden Age during the last week in July, finding that several key problems with management, nursing and dietary services remained.

Currie, who heads the regional office that certifies nursing homes for the federal government, reaffirmed the original decision, officially stripping the facility of its certification as of Saturday. Although patients now cannot use their Medicare of Medi-Cal benefits to pay for their stay at Golden Age, the facility is allowing them to remain until Sept. 7 at no extra cost because it did not issue 30-day eviction notices until Aug. 7, Horsman said.

In the meantime, relatives of Golden Age residents began taking matters into their own hands, dispatching letters to local newspapers as well as state and federal lawmakers.

After one meeting at the home earlier this month, relatives of more than 90 patients signed a telegram to President Reagan, Gov. George Deukmejian and other politicians asking that something be done. Others talked about forming a bandwagon trip to Sacramento to plead their case.

They argued that Golden Age is a fine facility that seems to have been singled out by the state.

“If they had enough inspection teams like this one, I bet they would run the majority of nursing homes out of existence,” Elaine Ayers said. “It’s like Golden Age got caught speeding, and all the other cars are still speeding by.”

Arthur Hoffman, whose 89-year-old mother lived at Golden Age, agreed. “It’s overkill. They’re throwing the baby out with the bathwater. That’s how we really feel.”

Although sympathetic to the home’s plight, lawmakers have in essence had their hands tied to do anything but watch the regulatory process in work.

“There isn’t anything that can be done about the decertification,” said Yvonne Murchison, an aide to Rep. Ron Packard (R-Carlsbad). “Obviously we’d like to avoid having these patients move, but we also want to see that facility come up to speed. We wouldn’t want anyone to be in a place that’s not safe, and I don’t think their families do either.”

While the home can reapply for Medicare and Medi-Cal funding at any time, Golden Age would have to undergo a 30-day trial without funding to demonstrate that any operating problems have been rectified.

Horsman, however, suggests it might be hopeless for the facility to reapply because the state has established “unreachable standards” for operation. As for the fines, the home plans to fight them during an upcoming citation review conference, he said.

In addition, the home is seeking a ruling on whether a state law allowing Medi-Cal benefits to extend 60 days beyond the decertification date--if no other beds are available--applies to it, Horsman said.

The home’s administrator has been kept busy in recent days meeting with relatives, one every half hour, to help with the chore of finding a new nursing home or determining whether the patient is fit to go home. Since beds in skilled-nursing facilities are scarce in the San Diego area, Horsman has been forced to direct relatives to facilities as far away as Yuma.

Nonetheless, the effort to relocate patients has been working well. Horsman said they have made arrangements for all but about 40 patients, those mostly being ones who need extensive nursing care. If necessary, those residents will receive assistance from state Medi-Cal officials to find new homes, he said.

Any move, however, can be profoundly upsetting to elderly patients. “To them, this is their home,” Horsman said. “It’s very traumatic for an aged person to be uprooted.”

While many relatives blame state and federal bureaucrats, Trujillo of the state Department of Health Services stressed that such arguments ignore a key factor.

“Basically, our hands are tied because of the lack of available beds in this area,” he said. “That’s the problem. That’s where the system breaks down.”

Most relatives have had no choice but to move their loved ones out of the county. The patients generally are too sick to come home, and many relatives cannot afford the costs of private care, which runs about $75 a day.

Indeed, the emotional fallout has been heavy.

For Terry Polcer, it was a sad and traumatic experience to put her mother, Rose Dreher, into a nursing facility once the 87-year-old woman became too ill with Parkinson’s disease to be cared for at home.

In recent weeks, Polcer has sat awake most nights, wondering what to do now that she must find a new nursing home for the aged woman.

“I haven’t even told my mother about this,” Polcer said. “I don’t know what she’s going to comprehend. But she’ll realize she’s being moved. She’ll wonder what’s going to happen now.”