Care Homes Fire Back Over Study : Nursing: An industry spokesman says that Medi-Cal under-funding forces some facilities to use drugs and physical restraints as a cost-saving measure.


Nursing home officials defended themselves Monday in the aftermath of a report by a state watchdog group that decried an excessive use of drugs and physical restraints in California’s nursing homes and called for stronger penalties for poor care providers.

The report estimated that between 68% and 80% of California’s 120,000 nursing home patients are in chemical and physical restraints on any given day, a percentage that “greatly exceeds any other state’s.” It was issued by the Commission on California State Government Organization and Economy, better known as the Little Hoover Commission.

David Helmsin of the California Assn. of Health Facilities, an industry group representing most of the state’s nursing homes, said chronic under-funding by the state Medi-Cal insurance program has in some cases forced nursing homes to use restraints as a cost-saving way to control patients whose behavior endangers themselves or others.

To reduce the number of patients in restraints requires more money for additional staff--not more regulations or punitive enforcement measures that the commission’s report recommends, Helmsin said.


Two-thirds of California’s nursing home residents’ costs are paid by the state’s Medi-Cal insurance program, which pays $65 a day. Helmsin said that works out to $11 a day below the actual cost of care, a deficit that nursing home operators try to make up by charging more affluent, private patients $90 a day.

Jack Markovitz, president of the nursing home association and owner of two Los Angeles-area nursing homes, said the report was a sensational collection of misleading anecdotes that do not accurately reflect conditions in most California nursing homes. He also charged that the commission’s chairman, Nathan Shappell, exhibited bias last September during hearings to collect information for the report.

“He went into the hearings with preconceived notions,” Markovitz said, adding that Shappell set a tone aimed at eliciting testimony about neglect of patients and excessive use of physical and chemical restraints.

Shappell could not be reached for comment Monday.


The 90-page report, “Skilled Nursing Homes: Care without Dignity,” was provided to The Times last week as California and federal officials continued to debate the implementation of federal nursing home reforms, which require patients to be maintained at the highest level of function and aim to reduce the use of drugs and harnesses to control unruly patients.

States where the reforms have been implemented have seen a 25% decline in the number of patients in restraints, according to the National Senior Citizens Law Center. Helmsin and Markovitz asserted that the report gives short shrift to controls on the use of restraints in effect in California. Current regulations require a doctor’s order, notes in the patient chart, written reports on adverse reactions and specific limits on how long the drug or device can be used, they said.

“In most cases the drugs are only used to control outbursts or acting out and we have doctors ordering them,” Helmsin said.