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| 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.
Full Article & Source:
Unmasked: How California’s largest nursing home chains perform
