NURSING HOMES: GAO Blasts Conditions In California Facilities
In a report to be released today, the General Accounting Office concludes that "nearly one in three" nursing homes in the state of California is guilty of "serious or potentially life-threatening problems." The Los Angeles Times reports that the "searing details" of an "intensive nine-month probe" conducted by the federal government of all 1,370 California nursing homes will be discussed today as the Senate Special Committee on Aging begins the first of two days of hearings on the issue. The reports of patient "[m]alnutrition, dehydration, urinary tract infections and bedsores that become gaping infected wounds" are likely "to touch off the biggest national nursing home controversy in years," the Times reports. "The GAO report is shocking. Enforcement is lax: Neglect a nursing home resident, get a slap on the hand. That is our system," said Sen. Chuck Grassley (R-IA), chair of the committee. "We're not talking high-tech treatments here; we're talking about basic care you would give your dog," said one GAO investigator.
We Don't Like Your Methods
The nursing home industry derided the accuracy of the report. "We have very serious reservations about the accuracy, the completeness and the methodology used in the (GAO) analysis," said Gary Macomber, executive vice president of the California Association of Health Facilities. According to the Times, Macomber said that investigators "had grossly inflated estimates of homes with serious problems, creating 'new categories' of danger, such as brooms leaning against the wall." He said, "It was a pretty poorly done piece of work" (Rosenblatt/Marquis, 7/26).
The AP/Contra Costa Times reports that the GAO probe focused on California nursing homes because of allegations brought up last year that "3,113 residents died in 971 California nursing homes in 1993 as a result of malnutrition, dehydration and other serious conditions." To address these concerns, the Senate committee "had researchers with academic nursing degrees and clinical experience conduct a review of medical records for a sample of the cases involving resident deaths" (Harris, 7/26). The investigators found that more than half the suspicious deaths (34 of 62) studied in California nursing homes "were probably caused by poor care," Time magazine reports.
Further, the "damning study" says that enforcement of rules regulating nursing homes in California is lacking (Thompson, 8/3 issue). The state Department of Health "said Congress needs to provide more funds for beefed-up policing of the facilities," the Wall Street Journal reports. Brenda Kurtz, "the agency's deputy director of licensing and certification," said better oversight "will not be possible nationally unless Congress is willing to fund the states. We've been flat-lined in our funding for the last seven years. We're hoping Congress finally steps up to the plate" (Hall, 7/27). However, the nursing home industry contends that "[e]nforcement activity alone is not the answer," according to Paul Willging, executive vice president of the American Health Care Association. He said that "a single-minded emphasis on enforcement will ultimately hurt quality."
National In Scope
The GAO pinned many problems on understaffing (Time, 8/3 issue). One Special Committee on Aging staffer commented that "if California, which has a reputation as a tough enforcement state, has such widespread problems, then 'it is hard to believe that things are better elsewhere.'" The GAO report noted that "although our report focuses on nursing homes in California, the problems we identified are indicative of systemic survey and enforcement weakness." The GAO also said "when state inspectors uncovered problems, the 'federal government generally took a lenient stance toward many of these homes." Grassley is considering expanding the probe nationally, the Los Angeles Times reports (7/26).
The GAO findings add to President Clinton's call last week for improved oversight of nursing homes. Last Tuesday, Clinton called for "new nationwide policies, including surprise nighttime and weekend inspections of homes and the creations of a national registry of workers who have abused patients," the Santa Barbara News-Press reports (Amerikaner, 7/25). In Michigan, advocates for the elderly say "they will be watching" Grassley's hearings "closely ... hoping true reforms will follow," the Detroit Free Press reports. Cathie Wallace, codirector of ACTION!, A Coalition for the Improvement of Nursing Homes, said: "We think it's great getting national attention" (Young, 7/27).
On The Hill Today
Today the committee will hear testimony from a former California nursing home resident, family members of former residents, current and former nursing home employees and a current state employee.Tomorrow, representative from the GAO and the Health Care Financing Administration and others will testify, including Dr. Charlene Harrington of the University of California-San Francisco and Dr. Dennis Stone of the California Association of Health Facilities (release, 7/28). "Above all, the absence of federal oversight is having a devastating effect upon nursing home residents. The hearing will provide a detailed and graphic illustration of the impact of weak federal enforcement in nursing homes," said Grassley (Detroit Free Press, 7/27).