Ailing Nursing Homes
New discoveries in medicine are extending people’s lives. But as the ranks of the elderly increase, so too will the number of those who will enter a nursing home at some point in their lives.
That prospect frequently causes fear. Those looking at entrance to a nursing home hate the idea of losing their independence. They worry about uncaring attendants, missed diagnoses of medical problems and dying before their time.
There are regulations ensuring that nursing home patients are treated well. Establishments that do not comply with the rules are supposed to be fined. But a Times review of inspection reports, lawsuits, medical records and death certificates for the past two years showed that regulation in Orange County is flawed.
Under state law, a nursing home fined for neglect of a patient need not pay the penalty if it’s the first one in a year. If other fines are paid within 15 days, the amount owed is cut by 50%. Of the $141,000 in fines levied on Orange County homes in 1996, only one-third was paid.
Of 89 licensed nursing homes in the county, 18 were cited for poor care last year. Half were threatened with a loss of Medicare funds, which is a major penalty. But only three actually had funds cut off. Additionally, there were a dozen deaths considered questionable at the 18 homes in 1996 and 1997. Only one resulted in the maximum $25,000 fine.
The cost of a month in a nursing home in Orange County runs from $3,500 up. Medicare pays only part of the cost for the first few months; after that, it’s up to the patient. When the patient’s funds run out, Medi-Cal picks up the cost. That means the taxpayers of California have a direct interest in how well nursing homes perform. The facilities have a moral duty to treat their patients well. They also have the duty to spend the money they receive wisely.
That means having enough trained staff to ensure that patients do not die from dehydration or infections. It means complying with federal rules barring the drugging or restraining of patients against their will. It means treating people with dignity regardless of their medical condition.
The Legislature has failed to pass several bills in recent years to increase the fines on nursing homes that mistreat patients. Those bills should have passed. But even before passing new bills, the existing punishments should be enforced.
Nursing homes complain about reams of regulations. But the regulations were instituted because of the horrific conditions of many nursing homes 15 or 20 years ago. And regulators can tell the difference between breaking a rule against dirt in a corner and one requiring a minimum standard of patient care to ward off death from causes such as dehydration.
The case of Port Bay Care Center in Newport Beach was especially egregious. Regulators let it stay open too long; only when it went bankrupt last year did it close.
Port Bay had its Medicare funding cut off four times from 1990 until last year. Yet each time the facility said it had corrected deficiencies, and the federal funds spigot was turned back on. Contrast that with Country Villa Plaza, which received bad marks in 1996 but improved dramatically when a new administrator was hired and demanded better performance by staff. That shows reforms are possible.
Government inspectors need to monitor nursing homes closely. Many of the patients have no family members to act as their advocates. Even when sons or daughters live close enough to visit regularly, they may not always spot problems. The state Department of Health Services and the county’s Council on Aging Long-Term Care Ombudsman Services can help those trying to decide which nursing home to choose. But once a patient enters a home, if the care is bad, the facility should be punished. Most homes in the county are well-run; those that are not should improve or be cut off from federal funds.
