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What Nursing Homes Won't Tell You

Stephen M. Garcia

One in five of the 15,700 nursing homes in the United States have consistently received poor ratings for overall quality, according to a recent USA TODAY analysis (Jan. 28, 2010), of government data.

This means that the research you do and the questions you ask are critical to the well-being and the quality of life your loved one will experience in the nursing home or long-term care facility you select for them.

But ferreting out the information is not always as easy as it should be. Here are five things nursing homes will not tell you.

1. Our report card isn’t as comprehensive as you think it is.

Late in the Bush administration the Centers for Medicare & Medicaid Services debuted Nursing homes are given a “report card” using a five-star system (five being best), for quality, staffing, and health inspections. They also are given an overall score. The information comes from state inspection agencies, which in California is the California Department of Public Health.

The information on the site often does not mean as much as advocates would like. According to the CDPH website, the state-wide average inspection is once in every 12 months.

Typically the inspector stays three to four days. What it gives is a “snapshot” of the facility, not necessarily an accurate view. For instance, we have heard reports of facilities calling staff in to work when the inspectors arrived.

If a facility does not meet the minimum state and federal standards for nursing homes, it is given a deficiency. In many cases, a facility can correct a deficiency by implementing a written plan of correction.

In our experience, the written plan of correction is not necessarily implemented. And even when it is implemented, the staff is not trained to make the correction.

For instance, in August 2008 after a resident atMetropolitanStateHospitalwas found to have committed suicide by hanging himself with the cord of the “call button,” a written plan of correction called for all “call button” cords to be tied to a bedpost.

However, inadequate staffing and a lack of staff training meant that it was not done, and in October 2008 another patient died by hanging. He, too, was determined to have wrapped the “call button” cord around his neck.

I can only imagine what effect state budget cuts have had on the nursing home inspection program.

2. It’s cheaper to be fined than to fix our deficiencies

If a nursing home does not meet state standards it may be fined, but in California, the state is lax about collecting the fines and often generous about reducing fines.

In fact, the situation has become so critical that in February 2010 the Legislature called for an audit to explore why state regulators are collecting only about one-third of the fines they levied against nursing homes in past years.

According to an investigative report (April 21, 2010) by California Watch, in 2005 the state collected 60 percent of the fines they assessed, about $1.8 million of $3 million. By 2008, state auditors levied fines of $5 million and collected about $1.5 million, less than 30 percent.

If a facility receives a Class B citation (for offenses that affect the health, safety, or security of a resident), the fine is $1,000. The type of citation and the fine can each be appealed.

If the facility does not appeal the citation, they are only required to pay 65 percent of the citation. If they do appeal the citation and/or the fine, the fine is frequently reduced. And if the facility pays promptly, it gets a 35 percent discount.

If a facility goes bankrupt, changes ownership, or does not accept Medi-Cal patients, the state writes off unpaid fines, the California Watch article reported.

3. We are understaffed and like it that way.

In our opinion, understaffing is the most critical source of nursing home abuse and neglect. Because of understaffing, residents are unsafe and frequently suffer pressure sores, falls, medication errors, over-medication abuse, and weight loss and dehydration.

Because of understaffing, residents may be restrained or not get the physical therapy they need. Understaffing goes along with a lack of staff training, as well as forcing staff to provide services they are not trained to perform.

We have actively, and in most cases successfully, sued nursing home chains for deliberately understaffing their facilities in order to increase profits.

We have seen these chains reward corporate management with significant bonuses, a practice that encourages management to save monies at the expense of the nursing home or long-term care facility resident’s health and safety.

If I had to select a nursing home or long-term care facility for a loved one and was only permitted to use one criterium, I would base my decision on how well staffed a facility is.

4. Background checks of employees are not really done.

Senate Bill 1759 passed the Legislature in 2006. It mandated state regulators to establish a centralized database for background checks of caregivers working in long-term care facilities. The program was never implemented.

According to a March 2010 Sacramento Bee article, an investigation by the state Senate Office of Oversight and Outcomes found at least 20 cases in which caregivers who lost certification as nurse assistants because of misconduct were cleared to work in a different type of facility also licensed by the state.

Without such a state-wide database, it is very easy for caregivers with dicey backgrounds that may include physical, financial, and even sexual abuse to move from facility to facility and from victim to victim.

The issue is currently being reviewed by the state Senate Subcommittee on Aging and Long-Term Care. But state agencies claim they never submitted for monies to fund the database because of budget shortfalls, a situation that does not appear to change soon.

5. When your Medicare runs out we’ll evict you.

More and more we are getting calls from people whose loved one is being evicted once his or her Medicare runs out. This is a sad trend across the country.

When a resident’s Medicare runs out they are moved to Medi-Cal. Facilities are reimbursed at a much lower rate than they get through Medicare.

Of course, there is no mention of this in the facility’s contract with your loved one. Ask if the facility will take Medi-Cal once the resident’s Medicare runs out prior to signing a contract. If you are verbally assured Medi-Cal will not be a problem, get it in writing.

Free Consultation with an Elder Abuse Attorney

If you think your loved one may be a victim of elder abuse or nursing home neglect, contact The Garcia Law Firm at (800) 328-2630 or at for a free, no-obligation consultation.


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