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Keep up nursing home oversight

Original source:

The Sacramento Bee
Editorial Board

Age happens, and with it the inevitable failings of health and independence. It’s too bad, then, that in California, where nearly 9 million baby boomers are gray or going gray, finding a reputable nursing home remains a roll of the dice.

As The Sacramento Bee’s Marjie Lundstrom and Phillip Reese reported last Sunday, regulatory actions taken by the state against one of the industry’s biggest players underscore the risks patients face as nursing homes have increasingly become commodities, bought, sold and run for profit.

Depending on luck – or the priorities of the owners – you or your loved one could end up in a home where mentally ill patients could live with the frail elderly without proper services or treatment. Or where nurses don’t know the correct way to clean wounds. Or where the staff thinks it’s funny to record videos of themselves mocking you while you’re asleep.

Quality nursing home care is labor intensive and often costly. But the bottom line can be Darwinian for the aged and ill. As health care for seniors has become a growth industry, many going concerns have become acquisition targets.

In some cases, new ownership has been good news. In others, far less so. And, for too long, state regulators have had a hard time keeping up with the changes. Indeed, another series last year by Lundstrom and Reese found that the strategies used by nursing home owners to protect themselves from litigation have masked such basic information as who owns which facility.

In recent months, though, the state has focused its efforts. This is welcome news, though what regulators have found is unsettling.

How to feel, for example, about the for-profit empire of Los Angeles businessman Shlomo Rechnitz, who has amassed 81 California nursing homes in less than a decade? He and his firms now control about 1 in every 14 nursing home beds in the state.

Chains bring economies of scale that owners say are good for patients. But the state argues that as this chain has ballooned, quality control has fallen.

It was in a Rechnitz nursing home in South Pasadena that a resident known to staff to be suicidal and delusional signed herself out one morning and set herself on fire. She was taken to a hospital and died 19 hours later – though the nursing home sign-out sheet would show her having returned to the facility.

Another of the chain’s homes near Auberry, northeast of Fresno, was shut down after the state documented numerous health violations, including a shoddy sewage system and brimming toilets. A 75-year-old mastectomy patient died in September of a wound infection; a foam sponge had been left to grow into her skin.

The federal government has decertified both nursing homes, along with a third in Butte County where the state issued a citation for the aforementioned video incident. And the state is fining Rechnitz, who told The Bee that he feels unfairly singled out by authorities.

The thing is, there’s an inherent conflict between running a business and tending vulnerable people, and the state has to start somewhere. Rechnitz’s operating margin in 2013 was about 11 percent, far higher than the average 3 percent margin at for-profit nursing homes statewide. Last year, serious deficiencies at his homes ran double the average per 1,000 beds when compared to California homes owned by others.

The state’s scrutiny shouldn’t end with this one chain, size notwithstanding. Getting old is enough of a gamble as it is.

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