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Operation Guardians - Aging Parents in Houses of Horror

Original source:

Carolyn Rosenblatt

Shocking conditions. Severe neglect. Filth. How is this going on? A generation’s worth of state and federal laws are supposed to keep aging loved ones safe in nursing homes. It’s not working.

In California, a nonprofit advocacy organization for nursing home residents, called California Advocates for Nursing Home Reform (CANHR) has just issued a scathing report of the condition of inspected homes. These houses of horror could be anywhere.

A bureau in the State Department of Justice launched Operation Guardians in 2000 to begin surprise, on-site inspections on CA nursing homes to protect residents and improve care for elderly and dependent adult residents. Good idea. However, the reports were not made available to the public. Bad idea. CANHR is believed to be the first organization to publicly reveal the reports. As each facility is inspected, two reports are issued. One assesses the general sanitation and care provided by the facility staff and another report is written by an experienced MD specializing in geriatrics.

The reports of the 14 facilities CANHR focuses upon are hair-raising. The conditions described expose severe neglect, filth, and inhumane care. Bedsores, overmedication with psychiatric drugs, medication mistakes leading to harmful overdoses, residents left in their own waste, filthy resident rooms, showers and kitchens and falsified medical records, as well as fraudulently billed services are among the life threatening findings. Maggots on a resident’s body. Unimaginable.

Why isn’t law enforcement doing anything about these deplorable problems? Part of the issue is that the reports themselves are not made publicly available and no criminal or civil prosecutions have resulted from them. The CA Attorney General’s office is asleep at the wheel when it comes to acting on these reports. It is a statewide embarrassment.

I suspect that these problems are far from unique to CA. Health and safety violations are rampant in nursing homes. I have worked in them myself. I remember how it was.

If you believe that your aging parent will never have to go to a nursing home and you therefore don’t need to worry, think again.

Nursing homes are not just for very ill persons near death. They are the places where long term care is delivered to our vulnerable elders, who could be your relatives being released from the acute hospital after a surgery. Physical and speech therapy after a stroke or a fall are usually delivered over time in a nursing home, also called “rehab facility”.

Your mom or dad, or your grandparent could end up in one, just because the acute care hospital where they went in the first place, for surgery or treatment, kicks them out after a certain time when Medicare won’t pay for them to stay in the hospital any longer. (Who doesn’t think hospital care is being rationed right now??)

What’s the takeaway here?

If your aging parent or loved one must go to a “skilled nursing facility”, aka nursing home or rehab facility, here are some things to keep in mind:

1. If possible, check out the nursing home choices online ahead of time. Some states report the department of health inspection reports and fines for failing to meet health and safety standards. Check the state Department of Health website for information. “Licensing and Certification” is the department that regulates and fines nursing homes for deficiencies in CA and it could be similar where you are. They are legally distinct from assisted living facilities.

2. If the facility accepts Medicare (many do), go to and search Nursing Home Compare. You can get some data there as to the most recent Centers for Medicare and Medicaid (CMS) reports of deficiencies. CAUTION: data may not be current, some is self-reported by the nursing homes themselves and it is not an adequate substitute for going out to eyeball the nursing home yourself.

3. Make a surprise visit yourself to the facility. You’ll learn a lot by looking, sniffing around and watching staff. If you have an opportunity to talk with any other resident’s family members, you will get the inside story of what’s good or bad about the home.

4. If you live at a distance from your aging loved one, hire a geriatric care manager (I admit to a bias for RN care managers) at and ask for recommendations for quality nursing homes in the area where your aging parent lives. Don’t just accept the suggestions of where the hospital discharge planner wants to send your loved one. It might not be a good place.

5. Be your loved one’s advocate. Do not trust that everything will be just fine all the time. Ask questions. Ask to see the records of treatment. Check for skin problems, inadequate fluid or food intake, and hygiene. Attend care conferences or send a representative, such as the care manager. Be the safety police.

We can keep aging parents safe in nursing homes, but it takes rather constant vigilance.

Until next time Carolyn Rosenblatt,