Unmasked: How California’s largest nursing home chains perform

Bonnie Nidiver of Paradise holds a photo of her late husband, Eugene, 88

First of three parts
One nursing home chain operating in California racked up abuse complaints last year at a pace seven times the statewide rate.

A large competitor placed one in every 15 of its long-term residents in restraints.

Still another corporate giant whose nursing homes dominate the Sacramento region experienced high nursing staff turnover at 90 percent of its facilities.

If you’re a consumer anguishing over the placement of a loved one needing full-time nursing, how would you know this?

The short answer: You wouldn’t.

As the population ages, and more families face the daunting task of choosing long-term care, consumers remain largely in the dark about the ownership of many California nursing homes – and their track records.

While industry officials contend they are intensely regulated by both the state and federal government, no single agency routinely evaluates nursing-home chains to gauge the overall care provided by their facilities.

Data are available for individual nursing homes, as federal, state and nonprofit groups keep records that chronicle staffing levels, bedsore rates and use of antipsychotic drugs, among many issues. But in California, the agency charged with overseeing these skilled-nursing facilities, the Department of Public Health, makes no effort to measure quality of care throughout a chain, or determine whether corporate policies and practices are contributing to any patterns.

Some companies doing business in California go to great lengths to create complex business structures, building layers of limited liability companies and partnerships with curious relationships to one another. The tangled corporate webs make it difficult for consumers and government regulators to identify who’s running the operations – and who should be held responsible when things go wrong.

“It’s a huge maze to try and figure out who owns what,” said Charlene Harrington, professor emerita of sociology and nursing at the University of California, San Francisco, who has spent 35 years researching the nursing-home industry.

“And that’s deliberately done.”

Yet knowing who owns what can be critical for fragile patients seeking long-term care, according to a Sacramento Bee investigation, which analyzed thousands of federal and state records detailing the ownership of the state’s 1,260 nursing homes.

In addition to identifying owners with at least a 5 percent stake in any California-based facility, The Bee also examined government and industry data to determine how the largest owners and their facilities performed on 46 measures, including quality-of-care indicators, staffing, complaints and deficiencies found during inspections. The analysis took into account the federal government’s star-rating system, as well as rankings determined by the nonprofit California HealthCare Foundation. State and federal inspectors logged most of the measures, although nursing homes self-reported patient care and staffing data.

Clear differences emerged among the state’s biggest operators. In the same way that restaurant franchises or department-store chains deliver similar experiences to consumers – for better or worse – The Bee found that some large nursing-home companies also produce systemic results.
Among the findings:

▪ In California, 25 for-profit nursing-home chains control about half of the state’s 120,000 licensed beds. The Bee found 10 of those chains – including the two largest, Plum Healthcare Group and a network owned by Shlomo Rechnitz of Los Angeles – performed below statewide averages last year in more than half of the examined quality-of-care categories, which gauge the incidence of problems such as pressure sores, infections and falls. Twenty of the top 25 chains fell below state averages in at least three out of five staffing measures.

▪ Some large chains have facilities suffering from the same care issues, despite being located hundreds of miles apart. For instance, within Plum Healthcare Group, which operates more nursing homes in the Sacramento region than any other company, 90 percent of the company’s 42 homes statewide last year had higher than average nursing-staff turnover. About 65 percent of the facilities owned by Longwood Management Corp. have higher than average rates of patients in restraints.

▪ Among the 25 largest chains doing business in California, the lowest performing in The Bee’s analysis are EmpRes Healthcare Management LLC and LifeHouse Health Services. Facilities owned by these chains consistently fell below state averages on most measures, and both owners were more likely to log complaints and federal deficiencies than most of their large competitors.

▪ Below-average staffing or high turnover were problems in nine out of 10 of the state’s largest nursing-home chains in 2012, the most recent year staffing data are available. The state’s largest chain, headed by Rechnitz, earned poor or below-average staffing ratings from the nonprofit California HealthCare Foundation in about 80 percent of its 54 homes. Even so, Rechnitz recently was given a federal judge’s blessing to purchase 19 more facilities.

Oversight of California nursing homes, and their owners, has waxed and waned over the years. In 2001 and 2002, under then-Attorney General Bill Lockyer, the state aggressively pursued chains by prosecuting two of the largest nursing home owners: Sun Healthcare Group of Irvine, and the California subsidiary of Beverly Enterprises Inc. In both cases, the state got permanent injunctions requiring that they improve care.

By contrast, the Department of Public Health was hauled before legislative leaders earlier this year amid charges it was dismissing hundreds of nursing-home complaints without adequate investigations. Assemblywoman Mariko Yamada, D-Davis, grilled health officials at the hearing and requested an audit of how the department regulates long-term care facilities.

“The state is not doing its job in protecting its most vulnerable residents,” said Carole Herman of the Sacramento-based Foundation Aiding the Elderly, who filed a lawsuit last year against the Department of Public Health charging it failed to promptly investigate nursing-home complaints.

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Unmasked: How California’s largest nursing home chains perform