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California and the West

Problems in Nursing Homes Detailed

Health care: Inspector testifies before U.S. Senate panel that many facilities in state do not provide adequate care.


WASHINGTON — In gripping testimony before a Senate committee, a California nursing home inspector--hidden behind a screen and her voice electronically distorted--charged Monday that state nursing home operators do not hire enough staff members to provide decent care and use their influence to keep aggressive inspectors away from their facilities.

The inspector, a registered nurse addressed as "Florence N." by members of the Senate Special Committee on Aging, outlined one case of neglect in which five women were beaten at night by another resident at an understaffed nursing home. "The five female residents were in the Alzheimer's unit, so the facility thought it was all right to allow the residents to get beaten up because they didn't know what was happening anyway," she said.

Summarizing the situation at many of the state's 1,370 nursing homes, she said, "The focus is no longer on patient care--the focus appears to be on warehousing the elderly, running the facility as cheaply as possible."

The testimony by the anonymous witness came on the first day of hearings focusing on problems in California nursing homes after a review by congressional investigators of inspection reports for the facilities. The review, detailed in a Times story Sunday, concluded that one in three of the facilities is plagued by "serious or potentially life-threatening problems."

Sen. Charles Grassley (R-Iowa), the committee chairman, said Monday he fears that an epidemic of neglect and abuse may exist in nursing homes far beyond California's borders.

"Is there a nationwide problem?" said Grassley. "I do not know, but I am going to find out."

Grassley disclosed that he has ordered the General Accounting Office, which reviewed the reports for the California facilities, to expand the scope of its probe.

"Probably other states have similar problems, and we will explore that," said the committee's ranking Democrat, Sen. John Breaux of Louisiana.

In Sacramento, a top regulatory official said the state is working diligently to maintain the quality of nursing homes despite budgetary restraints. State employees carry out the inspections, but the money for their salaries and expenses comes from the federal government.

Florence N., in her testimony, said the shortage of adequate staff at many nursing homes is the "catalyst for malnutrition, dehydration, decubitus ulcers [bedsores], urinary tract infections, fractures, burns and scaldings."

Brenda Klutz, deputy director of licensing and certification for the California Department of Health Services, acknowledged in an interview that too many nursing homes do not have enough employees to care for residents.

Many of the deficiencies documented in inspection reports "deal with inadequate staffing, especially at mealtimes," she said.

Florence N., in her testimony, charged that nursing home operators who do not like diligent inspectors complain vociferously to the state. The operators or their attorneys often convince state officials to keep certain inspectors away from their facilities, she said.

Klutz strongly denied any shifting of inspectors to accommodate the complaints of nursing home operators. "I don't take people off nursing home teams unless there is inappropriate behavior," she said.

Again blaming insufficient federal funding, Klutz said state inspectors have been confined to going to each nursing home no more than once a year without making repeat inspections of the ones with bad records. But she said that under a policy begun this month, the state will conduct two inspections a year at the worst two nursing homes in each of its 16 regulatory districts.

Other witnesses at Monday's hearing depicted a lack of care at some California nursing homes that is devastating for patients and their families.

Choking back tears, Leslie Oliva of Whittier described the ordeal of her mother, Maria Elena Espinoza, who suffered from a degenerative brain disease and died in March in a Riverside nursing home.

Her mother was beaten and suffered "malnutrition, dehydration and neglect," Oliva said. "She died as a result of this. I am not here just to speak for myself, but for millions of families," she told the committee. "Parents and families don't need to suffer this way. Congress and the president should see the ugliness, the neglect and the malnutrition our parents are experiencing."

Oliva's 8-year-old son, Michael, sat in the first row of the audience, just behind his mother at the table of witnesses.

Ellen Curzon of Lakeside told the committee about her late husband, Oswald, a mailman for 30 years, who became bedridden after suffering strokes. He was legally blind and had dementia. After caring for him for more than two years, she finally placed him in a San Diego nursing home costing $3,000 a month. In just six weeks, Oswald Curzon lost 35 pounds, developed bedsores on the buttocks "and became so dehydrated he flinched when touched," his widow testified.

"Every single day I had to literally hunt for someone to change him because when I would arrive at 10 a.m. he was always wet," she told the committee.

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