Our Elderly Deserve Better

Last summer Washington’s Government Accounting Office ripped Sacramento officials for failing to discipline hundreds of grossly negligent California nursing homes. Now, a year later, the state has yet to take action on oversight, leading some reform advocates to ask whether it ever will. They point out that the GAO study identified the same problems that the state’s Little Hoover Commission singled out in a 1977 report, one that the state all but ignored.

Can it get worse? Do our aged and ailing citizens have to put up with more years of neglect? Possibly not. Last month, legislators introduced several bills to strengthen nursing home oversight. They were motivated--finally--by the embarrassment of seeing California paraded as a national model of nursing home neglect and perhaps even more by the fiscal implications of a lower court ruling that the state Supreme Court upheld last week. That ruling awarded nearly $400,000 to the family of an 88-year-old woman who died when attendants at a Northern California nursing home left her bedsores unattended for days.

The state’s powerful nursing home lobby--which generated more than $3.5 million in lobbying and political contributions in 1996 alone--had argued that pain and suffering claims against nursing homes are capped at $250,000 by the state’s medical malpractice law. But the court said nursing homes were not necessarily protected by the cap.

Clearly, if Sacramento officials continue to turn a blind eye to negligent nursing homes they can expect a rising wave of lawsuits. Medi-Cal now sends $2 billion to nursing homes each year, a figure that has been growing with the increase in lawsuits and the graying of the state population.

Health and Human Services Secretary Grantland Johnson acknowledges that oversight is deficient but argues that “it’s going to take us a while to settle on a methodical approach” to reform. More than two decades of delay, however, are enough. Legislators should promptly pass a newly introduced bill by Assemblyman Kevin Shelley (D-San Francisco) that would implement reforms that The Times has long supported.

One of its key reforms is surprise inspections; presently the state inspects each home on the same week every year, giving ample time to conceal negligent practices. Another is increasing top fines from $25,000 to $100,000, money that could be used to pay for stronger oversight. A third would eliminate a state law that in essence allows nursing homes to inflate the numbers in reporting the hours that nurses spent with patients.

Looking to the longer term, the Legislature’s newly established Committee on Aging and Long-Term Care should begin work on reforms including stronger requirements for certified nursing assistants. California law requires them to undergo only 150 hours of training, mostly unspecified, while they work in nursing homes. By comparison, the state requires hairdressers to undergo 1,600 hours of specific training.

Requiring formal training of nursing assistants to enhance their skills, status and self-esteem is important. Caring for the elderly can be tough, low-paid and unrewarding work. But rather than second-guessing nursing aides, legislators should recognize that all Californians will benefit if aides are allowed to become professionals in every sense.

The GAO and the courts have identified the problems. Now state regulators need to push nursing home operators toward the solutions.