Nursing homes substandard
By Dana Bartholomew and Rodney Tanaka
Staff Writers

Tuesday, October 15, 2002 - Most nursing homes in Los Angeles County are understaffed and fail to meet federal health and safety standards, according to a statewide survey released Tuesday.

• Click Here to Find a Nursing Home Near you

Of 435 nursing homes in Los Angeles County, 79 percent failed to comply with minimum federal guidelines, according to the report.

That statistic held true in the San Gabriel Valley, where about 80 percent of the San Gabriel Valley's 40 nursing homes had deficiencies.

The California HealthCare Foundation-sponsored survey rated 1,212 California nursing homes to assist families and their doctors choose an appropriate residence via a consumer Web site launched Tuesday.

Consumers can check nursing home ratings concerning weight lost, bedfast, restraints, staff levels, wages, hours of average one-to-one care, state and federal deficiencies and other information at .

But local nursing home administrators said the Web site information doesn't give the whole story. People should also visit sites and do their own research before making a decision about placement.

The Web site information used comes from the latest public data from 2000-01, said Karen Hunt, spokeswoman for the California HealthCare Foundation.

People should check with nursing homes for the latest information, she said.

The survey found that elderly nursing home residents across the state suffered unnecessary weight loss, time in bed, bedsores, physical restraints, depression and pain.

"We found that most nursing homes, whether they were rated high or low, were not doing a very good job in providing assistance to residents - in not helping them eat, get out of bed, or go to the toilet,' said Charlene Harrington, a sociologist at the School of Nursing at UC San Francisco, who led the two-year survey.

"We think this is because of low staffing.'

Citations can be for anything from the wrong mesh on doors to the water temperature being off 2 to 3 degrees in the kitchen sink to a failure to date frozen peas in the freezer, said Betsy Hite, spokeswoman for the California Association of Health Facilities, which represents 1,300 skilled nursing facilities and centers for people with developmental disabilities.

Facilities are under incredible scrutiny, she said, and although they strive for perfection, it's virtually impossible for a facility to be deficiency free 365 days a year.

Gov. Gray Davis responded to the Web site announcement by launching initiatives to expand consumer monitoring and protection for seniors in nursing homes and increase penalties for nursing home violations.

The $2 million survey of state and federal nursing home data from 2000 through 2002 was conducted by researchers from UC San Francisco, UCLA, the RAND Corp. and the University of Wisconsin. Researchers also visited 34 of the highest- and lowest-rated homes.

Among the survey's findings:

In Los Angeles County, 54 percent of nursing homes failed to meet minimum nursing staff requirements, 10 percent higher than the statewide average for staff failures. The staff failure for Ventura County homes was 33 percent.

In Los Angeles County, 79 percent of nursing homes did not comply with federal health and safety standards, while 13 percent did not live up to state standards. The federal deficiency rate in Ventura County was 65 percent.

Staff turnover at nursing homes remained high, between 4 percent and 296 percent.

The study also reported that 20 percent of Los Angeles County nursing homes rated below average in rousing patients from their beds, and 26 percent deficient in devices used to restrain patients.

The survey follows a federal study in 1990 that found most nursing homes in the San Fernando Valley did not meet key standards for basic patient care.

Approximately 100,000 residents live at 1,406 nursing homes across the state, and the numbers are increasing. In 1990, Los Angeles County had 860,687 residents over age 65; in 2000, there were 926,673.

Nursing homes and industry advocates praised the ratings but had mixed concerns about some of its data.

"Very impressive,' said Jack Christy, director of public policy for the California Association of Homes and Services for the Aging, which represents about 400 nonprofit nursing homes or other senior services. "But it will never be a substitute for visiting a nursing home itself.'

Hite said the site underscores the staffing crisis California faces, but the picture isn't quite as bleak as it appears.

A new staffing standard was scheduled to go into effect in January 2000, requiring each nursing home resident to receive at least 3.2 hands-on caregiving hours per day, Hite said. The nursing shortage prompted the postponement of that requirement until April, but the Web site data does not take that three-month delay into account, she said.

The association's data shows most facilities are now staffed at 3.2 hours per patient and above, Hite said.

Accurate and understandable information is very good for consumers, but one single source will not be the final word on whether a facility is good, Hite said.

"We encourage people to visit nursing homes and do their own sensory test,' she said.

The reports should contain some narrative to explain the statistics, said Jack Hauck, administrator of Casa Bonita Convalescent Hospital in San Dimas.

"Reading is good but it's also very important to tour a location to have a sense of the ambience, to use one's five senses,' Hauck said.

Casa Bonita received average or better than average scores for staffing, evaluations and expenditures on nursing assistants and direct care.

The facility had below-average scores for residents who were in bed most of the time and residents who were put in physical restraints.

Patients with complex medical problems may be limited in movement, Hauck said.

California HealthCare Foundation officials said the ratings offer partial protection against substandard care.

"Until now,little or no objective information has been available to help people choose a nursing home based on quality,' said Mark Smith, president and CEO of the foundation, in a statement.

"This is the richest source of nursing home information ever generated for one state.'

-- Dana Bartholomew can be reached at (818) 713-3000.

-- Rodney Tanaka can be reached at (626) 962-8811, Ext. 2230, or by e-mail at .,00.html

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