Nursing a Desire to Improve Convalescent Care

In Louis Bersin’s line of work, death is a reality, but that doesn’t stop him from trying to be innovative.

The administrator of Oceanview Convalescent Hospital in Santa Monica, he’s intent on changing the way nursing homes work, and changing the way the public thinks about nursing homes.

“Nursing homes have the unfortunate reputation in this country of being places where people go to die,” he said. “The vision I have for Oceanview is that it be a place of inner growth and healing for our residents and their families, a place where people, in the words of Dr. Elizabeth Kubler-Ross, live until they say goodby, whether that’s to go home or over the horizon.”

Bersin, 37, is as comfortable quoting Jean-Paul Sartre as he is rattling off the latest California state nursing home regulations, which he says are more stringent than laws governing the nuclear industry. He has been the administrator of Oceanview for a year. The 227-bed nursing home is owned by Golden State Health Centers Inc., a privately held company based in Sherman Oaks that operates 21 facilities throughout California.

“You can tell a lot about a person through simply observing what they care about and how they care for it,” Bersin said. “I believe that it is through caring that we live the meaning of our lives.”

Watching Bersin do his brand of caring is to see him in the elevator wiping a tear from a patient’s eye or standing up at a memorial service and delivering a eulogy for a patient who has died with no one left to note his passing.

At one recent memorial service he attended, a relative of the deceased bluntly observed that people do not come to Oceanview by choice. Bersin acknowledges this, but says he is determined to add quality to the lives of those who had no choice.

Sandra Siegel, 56, one of the youngest residents, said Bersin has had a clear impact on Oceanview.

“I walked in 10 years ago with multiple sclerosis,” she said. “I’m from Beverly Hills, so you can just imagine what I (felt) when I came up against unconscious administrative decadence at its best--no taste and a hostile medical staff. When Lou came on the scene, some things changed. Louis is one of the reasons, along with my family and my nurse, that I am alive. Louis Bersin is a unique man. He loves life. He’s compassionate.”

Still, Siegel says, there’s ample room for improvement. “The decor is still abominable,” she said. “There should be more fresh flowers and maybe some aquariums. The uniforms should be pastel shades, and there should be beautiful music playing.”

Bersin, a graduate of Harvard University’s master’s program in health policy and management, is active in a group called the Santa Monica-West Los Angeles Clinical Research Cooperative. A consortium of 18 nursing homes, RAND Corp., UCLA Division of Geriatrics, St. John’s and Santa Monica hospitals, the cooperative is trying to develop and implement programs that improve communication among doctors, hospitals, nursing homes and other components of the medical community. The goal is to better manage people’s care.

Dr. Arthur Rivin, chairman of the group and director of medical education for Santa Monica Hospital, says the existing system is rife with problems.

“We found many examples of inappropriate care of patients being transferred from nursing homes to hospitals,” Rivin said. “For example, people with no-resuscitation orders were sent to the hospital after paramedics have seen them in cardiac arrest. The hospital doesn’t know how to treat them because the appropriate information had not been sent to hospital. I remember one patient was transferred on the weekend from a nursing home (and) the nursing home doctor was not available. The patient comes to the emergency room . . . and a new doctor starts from square one with no idea of whether the patient wants to do more testing.”

Besides better patient care, the consortium is interested in reducing costs. Rivin estimates that Santa Monica Hospital could save $750,000 a year by getting a grip on the problems associated with inappropriate transfers and inadequate records.

The main problem with nursing homes, according to Rivin, is that “they take care of frail old people using staff that is poorly paid and poorly trained. They are for-profit, which tends to keep costs down and income up. This is not to say that a for-profit nursing home like Oceanview can’t provide quality care. It just means that we have a long way to go. Oceanview does have the possibility to do just that.”

Bersin agrees. In the research cooperative, he heads a subcommittee whose job it is to devise a system for placing patients--particularly frail, elderly patients--in the least restrictive level of care appropriate to their condition.

Bersin says there need not be a conflict between doing well financially and doing some good for people.

Striking a proper balance is his challenge at Oceanview. Slightly more than half of the residents are supported by Medi-Cal, which reimburses the home at a rate of $67.41 a day. About one-quarter are supported by their own resources or private insurance and pay $100 a day. The remaining residents come from referrals from the Veterans Administration and various HMOs with pre-negotiated contracts. By keeping a close eye on costs, Bersin said, Oceanview makes a profit in the 5% range.

As he enters his second year at Oceanview, Bersin said he wants to introduce some holistic concepts like acupuncture, meditation and tai chi. He wants to run a seminar on the effect of attitude and thought on physical well-being. He wants Oceanview to become a model for what he says nursing homes of the future should be.

“Just because someone is failing physically,” he said, “doesn’t mean they can’t be soaring spiritually.”