Quality of Care at Nursing Homes

Overall, California’s nursing homes provide better care for their residents now than ever before. However, I also share many concerns expressed by The Times over the quality of care in some individual nursing homes (“In Questionable Health,” Jan. 18, “Ailing Nursing Homes,” Jan. 25).

While some facilities provide excellent care, others are only marginally maintaining compliance with state and federal requirements.

To establish an exceptional nursing home requires staff and management who are dedicated to their profession and who practice a philosophy of caring. These standards cannot be regulated into existence.

The Times implies that in some instances the Department of Health Services could have taken enforcement action against a particular nursing home but chose not to do so. However, it is often the facts of the situation, or the enforcement system itself, that prevent the department from taking a particular action.

As was discussed with you, the federal enforcement system is relatively new. After some experience in using the system and identifying gaps, California began working on a “focused enforcement” effort that places greater scrutiny on the worst facilities and those with a roller coaster history of compliance.

This initiative includes more frequent surveys of substandard facilities and a more direct linkage between poor care and license revocation or other enforcement.

Nursing homes are responsible for providing quality health care. When they don’t, we hold them accountable and take appropriate action to make sure that they do.

S. KIMBERLY BELSHE

Director

Department of Health Services

Sacramento

* Reading the article on nursing homes Jan. 18 brought it all back home. I don’t think anyone having experienced a loved one being in a “home” would ever want to go there again. There is no such thing as “peace of mind.”

In the 2 1/2 years that my dad was in assisted living and convalescent homes, it was a real lesson in the degradation of the human spirit. As human beings, we have a long way to go.

I don’t care if the lobby looks like a posh hotel, after you move someone in, it’s a whole new ballgame. My dad, who was dying from colon cancer, had his wedding ring stolen, his clothes misplaced and taken, his personal wheelchair taken for other patients’ use.

He was subjected to having to ring a bell for 20 to 45 minutes at a time when he needed to be taken to the toilet. Sometimes they would leave him there and forget to come.

His medications were often haphazardly given and sometimes his showers would just be a slam-dunk into icy cold water. When your parent is dying and suffering from partial dementia, you are not sure who to believe. Whatever you do, don’t take the word of the staff.

The only remedy I had was to attend the assisted living home four to five times a week and make sure they were consistent with my father’s care.

The bottom line for nursing homes is not compassion and service; the bottom line is profit. Anyone who begs to differ has not spent enough time there.

VIRGINIA MISCIONE

Orange

* I appreciate that you printed my letter regarding your Jan. 25 editorial, “Ailing Nursing Homes.” Unfortunately, in editing my letter, you made it sound like we’d like an enforcement system that focuses on quality paperwork. That couldn’t be further from the truth.

My original letter read, “We’ll never get away from the need to have rules and regulations, but it’s essential that we move toward a system that focuses on quality care--not quality paperwork.”

The current system unwisely focuses on paperwork and red tape, instead of developing systems to evaluate whether patients are receiving the appropriate care to meet their health care needs.

GARY D. MACOMBER

Executive Vice President

California Assn. of Health Facilities

Sacramento