California Understates Problems at Nursing Homes, Report Says

California is one of several states in which health officials underreport deficiencies and harm to residents at its nursing homes, according to a recent report by the U.S. Government Accountability Office.

From July 2003 to January 2005, California inspectors found serious deficiencies at 6% of nursing homes, down from a high of 29% in 1999. By comparison, Connecticut found serious deficiencies at 54% of its nursing homes.

After having a clinician review the state’s reports, “We found that actual harm was understated,” said Walter Ochinko who led the GAO study. “I think our work showed, in fact, some of these homes aren’t better.”

Under contract with the U.S. Centers for Medicare and Medicaid Services, states conduct annual nursing home inspections to assess compliance with federal quality and safety requirements. States also investigate complaints filed by family members or others.

The California Department of Health Services, which regulates nursing homes, took issue with some of the GAO’s conclusions.

“We firmly believe that part of the decline in the scope and severity of deficiencies being identified is because we detect so many more things at an earlier stage and require nursing homes to correct them before they get to the point where they harm residents,” said Brenda Klutz, head of the division that oversees nursing homes.

In addition, she said, the department has received conflicting instructions from the federal government as to what deficiencies should be reported.

For instance, at one point, the state was told to stop citing facilities for bedsores, then it was faulted for not doing so, Klutz said.

The GAO findings, published last month, were consistent with those of a Times analysis of state data last July.

The newspaper determined that California’s health department had sharply cut enforcement of state laws aimed at protecting the state’s 100,000 elderly nursing home residents, even as complaints about the quality of care rose.

The Department of Health Services issued 36% fewer citations for state health and safety violations in 2004 than the average number in the previous four years, an analysis of state records showed. The total amount of fines fell 36% from the average of the previous three years, after new, larger fines were authorized. Meanwhile, complaints rose 23% from the average of the previous four years.

The GAO study looked at enforcement of federal rules, which state officials have said tend to take priority over state rules because enforcement is backed by federal money.

In addition to finding that problems were underreported, the GAO found that the timing of California nursing home inspections was too predictable.

Almost 28% of inspections are held within two weeks of nursing homes’ last annual inspections, the report found. Nationwide the percentage is about 14%.

California Advocates for Nursing Home Reform, a watchdog group, maintains that the GAO report shows the state’s oversight system is broken.

“We don’t challenge the idea more resources might be needed, but we see time and time again what is reflected in this report. They either understate [problems] or dismiss them or take so little action there’s no deterrent effect for nursing homes,” said Michael Connors, an advocate with the organization.

The group, along with relatives of two former nursing home residents, sued the state last October for allegedly failing to investigate complaints promptly. The suit is pending.

“We hear complaints all the time from people whose loved ones are in danger or who have already died” and the state has classified their cases as not urgent, he said.

Ann Coleman of Newcastle, in Placer County, filed a complaint with the state about the Foothill Oaks Care Center in Auburn last November, saying that the quality of care that her 92-year-old father, Laverne Staples, had received was unsafe and substandard.

For example, he once was found lying on the ground outside with his wheelchair on top of him, she said.

Soon after that, she said, Staples was transferred from the nursing home to a hospital in a coma. Doctors found that his kidneys had shut down.

Before Coleman’s complaint was investigated, her father died. Staples’ funeral was last week.

An employee of the legal affairs office at Horizon West, the corporate parent of Foothill Oaks Care Center, declined to comment.

The California Assn. of Healthcare Facilities, a nursing home industry group, maintained that the state’s facilities generally provide good care for their residents. But spokeswoman Betsy Hite said funding has not grown with the needs of residents.