Nursing Homes’ Shame

The elderly, often disabled people who live in the state’s nursing homes deserve--at the very least--proper nutrition and attention to common medical problems. But according to a federal Government Accounting Office report released this week, nearly one in three California nursing homes is plagued by “serious or potentially life-threatening” problems and fails to provide even a rock-bottom level of care.

The U.S. Senate, holding hearings on the report, on Tuesday ended two days of emotional testimony in which one registered nurse who evaluates nursing homes for California--her face covered by a hood and her voice electronically distorted--said that the facilities were able to “warehouse the elderly . . . as cheaply as possible” largely because of their owners’ political influence, which she said kept aggressive inspectors at bay. The trade group that represents California nursing homes is a formidable force in state politics: In 1996, it spent $728,000 on lobbying and campaign contributions.

But the GAO report hits hardest at the laxity of state and federal officials. Kimberly Belshe, director of the state Department of Health Services, correctly rails about ridiculously lenient federal laws that grant most homes a grace period of 30 to 45 days to correct deficiencies without penalty and accept a nursing home’s written declaration that it has corrected its problems. She also says federal regulations inhibit the state’s ability to impose penalties on grossly negligent nursing homes.

The truth is not so lopsided: The state has substantial authority to impose fines on violators. It could have more if the Wilson administration had not helped gut a state bill meant to toughen sanctions against nursing homes. That pending bill, by Assemblyman Martin Gallegos (D-Baldwin Park), would have increased the top fine the state could levy from the current $25,000 to $100,000. But after pressure from the Wilson administration, state legislators dropped the higher fines and in fact added a provision for a 35% reduction in fines to nursing homes that do not appeal their penalties.

Reacting to the GAO report, both state and federal officials promised better enforcement and oversight. But more fundamental reform is needed: restoring the fines in the Gallegos bill, changing an outrageous state law that allows nursing homes to greatly inflate representations of the amount of care provided by registered nurses and licensed vocational nurses, and setting clear, minimum staffing levels so one nursing assistant isn’t hand-feeding two dozen patients.

Reforms are vital to prevent government Medicare and Medi-Cal dollars from being squandered. Last year, those programs paid approximately $2 billion to California’s 1,400 nursing homes. The public costs will keep rising: By 2030, the number of Americans 85 and older is expected to double. But the humanitarian reasons are the strongest. The abuses documented this week in Congress are inhumane and unconscionable. State and federal regulators need to confront them with specific reforms, not bureaucratic excuses and finger-pointing.

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Who Pays

The average cost in California for nursing home care is $3,460 per month, paid in most cases by public funds.

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HMO or private payments: 29%

Medi-Cal: 64.5%

Medicare: 6.5%

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Nursing home ownership

Investor owned / for profit: 80%

Nonprofit: 15

Government-run: 5

Source: Office of Statewide Health Planning and Development, 1996 data