Ownership, Performance Data on State Nursing Homes Lacking
California consumers lack information about the ownership and performance of many California nursing homes, the Sacramento Bee reports.
Although federal, state and not-for-profit groups track certain information about nursing homes, there is not a single agency that regularly assesses the quality of care provided by nursing home chains. The California Department of Public Health is tasked with overseeing skilled-nursing facilities in the state, but the agency does not measure care quality throughout a chain or try to identify whether corporate policies lead to any patterns, according to the Bee.
Further, some firms have complex business structures making it difficult for consumers and government agencies to identify who is running the organizations and who should be held accountable.
Charlene Harrington, professor emerita of sociology and nursing at UC-San Francisco, said, "It's a huge maze to try and figure out who owns what," adding, "And that's deliberately done" (Lundstrom/Reese, Sacramento Bee, 11/8).
Who Owns California Nursing Home Facilities?
Many nursing home chains do little to market or promote themselves, with some privately-owned chains operating "in near-reclusion," the Bee reports.
For example, a review by the Bee found that 10 of the 24 largest nursing home chains operating in California did not have a website or only had a site with few details about their facilities or location.
The federal government's database -- though incomplete -- shows that nursing home ownership in California ranges from family trusts to pension funds to big Wall Street players.
Meanwhile, most of the top executives at the largest for-profit nursing home chains have background in areas, such as real estate, investment banking, finance and law, rather than health care.
Eric Carlson of the National Senior Citizens Law Center said, "The bottom line is, you've got somebody who is not that concerned about quality of care, who's treating nursing facilities as simply a money-making operation with no real interest in -- or intuition for -- the practice of providing care."
However, Mark Reagan, legal adviser for the California Association of Health Facilities, said, "There are many executives who grew up in long-term care who do have the care background." He added, "I do see a lot of health care experience within the folks I deal with" (Lundstrom/Reese, Sacramento Bee, 11/9).
State Falling Short in Disclosing Ownership Data, Advocates Say
In 1997, the California Legislature began requiring DPH -- then the state Department of Health Services -- to collect "accurate and up-to-date" information on nursing home ownership and make it readily available to consumers.
In 2004, the California Advocates for Nursing Home Reform sued the state over the lack of nursing home transparency. State officials signed an agreement saying they would comply with the law. DPH agreed to list the names and addresses of all individuals with a nursing home ownership stake of at least 5%, and the state said it would provide the names and addresses of parent groups if the nursing home was a subsidiary.
The state launched an online Health Facilities Consumer Information System, which lets users search information on individual nursing homes. However, the data included on the site are incomplete and often misleading, the Bee reports.
DPH spokesperson Corey Egel said the department routinely verifies nursing home ownership data during surveys and investigations into complaints. However, the department "must rely on facilities to self-report (ownership) changes."
Further, the site only provides licensee and facility information and lacks specific ownership data.
Egel said DPH stores ownership data in an in-house "licensing database" and only makes information -- sometimes redacted -- available to residents who file a California Public Records Act request.
As a result, the California Advocates for Nursing Home Reform has filed another lawsuit against the state alleging that the department is violating the law by not adequately investigating ownership groups before proposed sales and acquisitions. The suit alleges that the state only examines ownership structures at the nursing home facility level or one ownership level above, "creating an enormous loophole for all multilayer nursing home organizations."
DPH said it could not comment on the pending litigation, according to the Bee (Lundstrom/Reese, Sacramento Bee, 11/10).
Bee Analysis on State Nursing Homes
The Bee conducted an investigation into the state's 1,260 nursing homes by:
- Analyzing thousands of federal and state records on nursing home ownership;
- Identifying owners with at least a 5% stake in any California-based facility; and
- Examining government and industry data to determine how the largest owners' facilities performed on 46 measures.
The investigation found that:
- 25 for-profit nursing home chains control about 50% of the 120,000 licensed nursing home beds in California;
- 10 of top 25 chains performed below state averages in more than half of the examined care quality measures last year;
- 20 of the top 25 chains fell below state averages in at least three out of five staffing measures; and
- Nine out of 10 of the state's largest nursing home chains had below average staffing or high staffing turnover in 2012, the most recent year staffing data were available (Sacramento Bee, 11/8).