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Bill seeks faster investigations into complaints against nursing homes

Original source:
Los Angeles Times

The state has left some cases unresolved for a year or more, leaving families to fear their relatives will face harm and negligence in the interim.By Charles Ornstein, Los Angeles Times Staff Writer
October 2, 2007

Octavio “Nito” Jimenez’s relatives remember being told by staffers at his Oxnard nursing home that he had “a little sore” on his foot.

When the 81–year–old was admitted to an acute–care hospital in July 2006, however, a doctor found deep and infected wounds on his heel and buttocks.

“He just said that it was really ugly and it was really bad,” recalled Jimenez’s daughter, Alice Trejo.

Jimenez’s stepdaughter, Josie Valdez, filed a complaint with a nursing home ombudsman in Ventura County, who immediately notified state inspectors by fax: “Family is very concerned they will lose their father from neglect” at Maywood Acres Healthcare.

Within days, Jimenez was dead from an apparent heart attack, and for more than a year afterward his children heard nothing from the state. Maywood Acres administrator Robert Stauff, who took over months after Jimenez’s death, said he was unaware that a complaint had been filed.

“To this day, nobody has been able to tell me what the findings were,” Valdez said last week. “It hurts families and it hurts the person unable to care for themselves.”

Jimenez’s case is among many cited by advocates of a bill that would require the state Department of Public Health to fully investigate most complaints against nursing homes within 40 business days.

The bill, sponsored by Assemblyman Mike Feuer (D–Los Angeles), passed the Legislature last month and is now on the desk of Gov. Arnold Schwarzenegger. The governor’s press office said he has not yet taken a position on the legislation.

On any given day, about 115,000 Californians are living in nursing homes, the majority of whom are older than 75. State data show that 316,500 residents were treated in nursing homes in 2005, most for two months or less.

Resident advocates say Feuer’s bill, Assembly Bill 399, is needed to quickly flag problems and ensure they are corrected. Sometimes, as cases languish, residents remain in danger. And even when a resident has died or recovered, advocates say, there is little oversight to prevent patterns from being repeated or to bring errant employees in line.

The longer an investigation drags on, the greater the chance that witnesses will forget key facts and staffers will move on.

“A timely investigation with timely results can make the difference literally between life and death sometimes,” Feuer said. “Forty days is plenty of time to conduct a meaningful, finely grained, detailed investigation.”

In recent years, some complaints appear to have landed in a black hole. Families have settled their lawsuits against nursing homes in a shorter span than it takes the state to resolve their inquiry, advocates say.

Consider these delays:

  • One year to investigate and impose a $100,000 fine against Westgate Gardens Care Center after an unattended 77–year–old resident choked on a grape and later died. Instructions in the resident’s records indicated she was not to be served whole fruits or left alone when she ate.
  • Eleven months to investigate and fine Beverly Healthcare Center in Stockton $80,000 after its air conditioner failed during a heat wave in July 2006. One resident died from hyperthermia caused by the high temperatures and another resident was taken to the hospital with the same condition, the state said. The home has since changed its name to Golden LivingCenter–Stockton.
  • Fourteen months to cite Manorcare Health Services in Hemet after an 83–year–old dementia patient fell out of his wheelchair, suffered a brain hemorrhage and died. He was supposed to be placed in chair with a lap cushion to prevent falls. The home was fined $75,000.

All three homes said they disagreed with the state’s conclusions and were appealing their fines. The Stockton home, for instance, said its staff were “not treated fairly by not being given credit for the admirable job they did when faced with the challenge of a ‘naturally occurring weather event‘ that was well beyond human control.”

Even so, some homes said they supported more timely investigations by the state.

“Time fades memories, destroys facts, makes things ambiguous,” said Ralph Agnello, executive director at Westgate Gardens.

The nursing home industry, as a whole, does not oppose the bill, said Betsy Hite, a spokeswoman for the California Assn. of Health Facilities.

“We really want the truth,” Hite said. “If something bad happened, we don’t want that to happen again.”

At the same time, she said, “a timely investigation might turn up the fact there is nothing to substantiate — and that’s a good reinforcement for the staff as well.”

Despite facing little public opposition, the bill may be doomed for lack of funding.

The Public Health Department told the Legislature that it would have to spend an additional $6.5 million annually to complete all investigations within 40 working days. The bill includes some exceptions for complicated cases.

Bet Tzedek Legal Services and California Advocates for Nursing Home Reform, both of which lobbied for Feuer’s bill, said the state needs more money regardless of the legislation, because worrisome incidents are on the rise.

“What’s the point of having an oversight system if you’re not going to take these things seriously and you’re not going to do it in a timely manner?” asked Patricia McGinnis, executive director of the reform group.

“If I told people in my office you have to start your work every week but there’s no deadline for finishing anything, good God. They should feel some kind of urgency.”

The state has been under pressure to improve nursing home oversight for years. In September 2006, a San Francisco Superior Court judge ordered the state to begin investigating nursing home complaints within 10 working days, as required by law. He turned away protests from the state that it might take a year or longer to comply, giving an eight month deadline.

Since then, the licensing and certification office has eliminated its backlog of untouched cases, thanks in part to the increased hiring of inspectors, authorized last year by the Legislature.

But the time it takes to complete the investigations is still an issue.

Of complaints received by the state between Oct. 1, 2005, and Sept. 30, 2006, about 60% were not completed within 40 days and half were not done within 60 days, according to data from the California Department of Public Health.

The agency made some progress among complaints received between Oct. 1, 2006, and March 31, 2007.

Still, more than 30% were not completed within 60 days, data show.

State health officials declined to discuss Feuer’s bill because it is now in the governor’s hands. But a top official acknowledged that the investigation into Jimenez’s care was delayed for too long.

She said her staff visited the nursing home in December 2006, five months after the complaint was filed, but were unable to talk to several people involved in Jimenez’s care because they no longer worked there.

Billingsley said the state notified Maywood Acres in December that it intended to issue a citation in the case, but that still hasn’t taken place.

After The Times pointed out the delay in the case last week, Billingsley said her staff contacted Jimenez’s family and affirmed the state’s commitment to resolving the matter quickly.