"List of bad nursing homes called inadequate"
By LORA HINES
10:00 PM PST on Monday, December 3, 2007
Nursing home watchdog groups say a recently released list of the country’s poor–performing nursing homes by the Centers for Medicare and Medicaid Services is incomplete and misleading.
The list identifies 54 facilities, including one in California, that Medicare and Medicaid says "have had a history of serious quality problems," according to a written statement from the federal agency. But Medicare and Medicaid did not reveal the names of 74 other poor–performing nursing homes that also are in a special oversight program. As many as five additional California nursing homes could be among them.
It is the first time Medicare and Medicaid has publicly identified facilities in its special focus facility program. No one would say whether the whole list would be released.
Last week’s partial release of Medicare and Medicaid’s list came as the state’s nursing home regulator, the California Department of Public Health, announced that a Fontana facility, which is not on the list, had been fined for the second time in three years in a resident’s death.
Medicare and Medicaid officials defended their list, saying it would offer people powerful new information when choosing a nursing home.
"Release of this national list of special focus facilities reinforces (the Centers for Medicare and Medicaid’s) commitment to provide beneficiaries and their families the information they need when making long–term care choices," said the agency’s acting administrator, Kerry Weems, in a written statement.
Medicare and Medicaid hasn’t yet responded to a request for all California nursing homes recommended for the special focus facilities program. The California Department of Public Health won’t identify them, saying it’s Medicare and Medicaid’s responsibility.
Mike Connors, spokesman for the consumer advocacy group California Advocates for Nursing Home Reform, said the list would lead people to believe that only one of the state’s 1,400 nursing homes is a poor one.
"It’s horribly misleading and inadequate," he said. "Are consumers to believe there is only one nursing home in all of California they should avoid due to bad care?"
The list’s release was a result of proposed federal legislation that would require nursing homes to disclose ownership and regulators to provide information about poorly managed homes to help consumers make better choices.
An estimated 1.5 million people live in the nation’s 16,400 nursing homes, where residents require help with almost all tasks, such as taking medications, eating and bathing.
Almost 317,000 people were admitted to California nursing homes in 2005, according to a February study by the California Healthcare Foundation.
Riverside County has 52 licensed nursing homes with 4,622 beds. San Bernardino County has 54 nursing homes with 5,012 beds.
Failure to Meet Standards
Medicare and Medicaid’s list comprises nursing homes that have failed to meet federal quality standards, which are based on the number and severity of deficiencies found during their last three annual inspections.
Nationwide, nursing homes average eight deficiencies per inspection, according to Medicare and Medicaid’s Nursing Home Compare Web site. California nursing homes average 13 deficiencies per inspection, the Web site states.
Inspectors have found even more at some Inland facilities, including 25 during an October 2006 inspection at Pleasant Care Convalescent in Riverside. They documented 19 deficiencies at Devonshire Care Center in Hemet during a December 2006 inspection.
The oversight program was created in 1998 to identify poor–performing nursing homes and push for improvement. Every four months, Medicare and Medicaid identifies as many as 15 nursing homes in each state that require more oversight, called the special focus facility initiative.
In California, the Public Health Department then selects six of those facilities to be placed in the program. Nursing homes that don’t improve within at least 18 months could lose Medicare and Medicaid funding, which most facilities rely upon to operate.
"We’re talking about places on this list that already have been out of compliance for 3 ? years," said Toby Edelman, an attorney with the Washington–based consumer group Center for Medicare Advocacy. "There are other big lists of candidates that aren’t on it. It doesn’t mean anything."
Better Enforcement Sought
No one wants nursing homes to lose Medicare and Medicaid funding and close, Edelman said. Advocacy groups want facility inspectors to better enforce regulations and penalties to mandate compliance.
"That’s what we don’t see," she said. "This list is a very small piece of what (Medicare and Medicaid) should be doing. The chances of anyone looking at a particular facility on this list is very minimal."
Kathleen Billingsley, deputy director of the Center for Healthcare Quality in the state Public Health Department, wouldn’t say whether Medicare and Medicaid’s release of a partial list of poor–performing nursing homes is fair to consumers.
"I think this is a positive first step," Billingsley said. "This is more information than they had before."
Edelman said she fears consumers will base their decisions solely on an incomplete list.
"It’s not a great tool for people to use," she said.
Meanwhile, a state Public Health Department Web site that will release nursing home information –– including fines, complaints and inspection correction plans –– is supposed to be ready by April, officials said. State law required the Web site to be updated four years ago.
Medicare and Medicaid’s nursing home Web site shows facility inspection deficiencies. It does not include deficiency explanations, fines, citations or complaints.
Inland Widower Concerned
Byrd Miller, of San Jacinto, said he couldn’t find anything about his wife’s nursing home on Medicare and Medicaid’s Web site. Norma Miller, who was 69, died Sept. 16 of congestive heart failure at the couple’s home. Byrd Miller said he took his wife home out of Devonshire Care Center in Hemet because it failed to provide decent care. He had placed her in two other centers before taking her to Devonshire, he said.
"I’m blaming myself," Miller said. "They don’t care. They’ve got a patient lying in there who is helpless. Why isn’t the government doing anything about it?"
Neither Devonshire’s administrator nor anyone at Summit Care Corp. in Foothill Ranch, which owns the facility, could be reached Monday.
On Aug. 15, Miller complained to the state Public Health Department after his wife fell as she tried to get in a wheelchair after using the bathroom. She had called for assistance but no one responded, he said.
Investigators didn’t validate Miller’s complaint, which he has appealed to Billingsley, he said.
Miller said he is encouraged by Medicare and Medicaid’s list of poor–performing nursing homes.
"It’s a start," he said. "There are three others that need to be on it."
Medicare and Medicaid: To see the federal agency’s partial list of poor–performing nursing homes, go to www.medicare.gov
California Advocates for Nursing Home Reform: For more nursing home information, go to www.nursinghomeguide.org