California HealthCare Foundation Releases Report on Nursing Home Quality

More than 75% of nursing homes in the state do not meet federal quality standards, and 44% violate the state's minimum nurse staffing level requirements, according to a study released yesterday by the California HealthCare Foundation, the Los Angeles Times reports. The study was based on 32 months of data from nine public databases that included nursing home inspection information and financial reports (Ornstein/Krikorian, Los Angeles Times, 10/16). Researchers from the University of California-Los Angeles, the University of Wisconsin and RAND conducted the $2 million study (Weaver Teichert, Sacramento Bee, 10/16). The study found:

44% of nursing homes did not meet a state requirement to provide 3.2 nursing hours per resident per day, and 92% of homes did not meet the federal standard of 4.2 hours (Russell, San Francisco Chronicle, 10/16).
Nursing homes statewide had an average annual staff turnover rate of 78%, and some facilities had a rate as high as 296% (Feder Ostrov, San Jose Mercury News, 10/15).
Only 23% of nursing homes statewide were in "substantial compliance" with federal standards, and 15% had "very serious" deficiencies (Sacramento Bee, 10/16).
Inspectors at 30 nursing homes selected at random found that residents at the facilities "did not receive as much care as their charts indicated" because employees overreported the number of times residents received assistance with certain tasks, the Times reports.

In addition to the report, CHCF launched a new Web site to provide the public with access to "detailed information" on the state's 1,406 nursing homes (Los Angeles Times, 10/16). The site provides information on specialized services, staffing, employee turnover, complaints, state citations and fines, facility ownership and bankruptcy information for individual nursing homes (Sacramento Bee, 10/16). "This is the richest source of nursing home information ever generated for one state," CHCF President and CEO Mark Smith said (San Francisco Chronicle, 10/16).

Some Criticism

However, Betsy Hite, director of public affairs for the California Association of Health Facilities, criticized some parts of the nursing home study (Sacramento Bee, 10/16). She said that the study "holds nursing homes to standards that were not enforced at the time some of the data were collected." For example, the state did not enforce the minimum nurse staffing level requirement of 3.2 nursing hours per patient per day until April 2000, although the data were collected for all of 2000 (San Francisco Chronicle, 10/16). In addition, Hite said that she considered some of the "serious deficiencies" cited in the report -- such as a tissue left on the floor or a two-degree difference in water temperature -- "unfair." She added, "I'm not sure we're really giving the consumer an actual idea of the quality of care in a home." Dr. Robert Kane, a professor of long-term care and aging at the University of Minnesota School of Public Health, added, "We have a long history of experimenting with various kinds of report cards in the health business, and the history is very dismal. I don't think that simply raising people's anxieties about the quality of care is the same thing as improving it" (Los Angeles Times, 10/16).

State Proposals

After the release of the report, Gov. Gray Davis (D) announced three long-term proposals to improve the state's nursing homes. The proposals include:

Doubling low-level fines on nursing homes to $200 to $2,000 and tripling fines for repeat offenses that occur within two years of the first offense.
Expanding the Health Facility Consumer Assistance Center pilot program, which provides information on nursing home quality over the Internet, to include statewide information.
Spending $2 million to $3 million to train an additional 650 volunteers for the Longterm Care Ombudsman Program, which helps monitor nursing home conditions (Peele, Contra Costa Times, 10/16).

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