YOU ARE HERE: LAT HomeCollections


Seeking a Remedy for Nursing Homes' Ills

With tragic lapses in care all too common, legislators want to beef up training and wages for the overworked nurse assistants who shoulder key responsibilities.


SACRAMENTO — Your hairdresser had 1,600 hours of training. Your veterinarian's assistant studied for two years. But the nurse's assistant caring for your frail grandmother needed only 150 hours of instruction to get a state license--most of it gained on the job with scant government oversight.

Combine that with poor pay, the increasingly sick population of California's nursing homes and huge patient caseloads--an average of 10 patients per assistant--and you have a combustible brew long ignored in nursing home reform efforts.

Disaster inevitably strikes, its human toll filling the pages of government citations against the homes: The nurse assistants drop your grandmother and bones break. They attach a bed restraint improperly and she suffocates. Or they neglect to wash their hands and she gets an infection that sends her to the hospital, or the morgue.

San Fernando Valley attorney Orrin Turbo chose a facility carefully after his mother's stroke. Only later did he learn that the facility's real nurses spent most of their time doing paperwork and distributing medicine, while the "nurses" caring for his mother were ill-prepared and poorly treated nurse assistants.

Still, Turbo was shocked to find the 76-year-old sitting up in her bed, naked from the waist up. Her fingernails had not been trimmed for more than two months. One day he found an open container of iodine in her doughnut box.

"I was told this was one of the best places," said Turbo, who recently moved his mother to a smaller, better staffed home. "It made me wonder what the others were like."

Amid mounting pressure from baby boomers with aging parents, nursing home reform is moving to a political front burner in California that it has not occupied in more than a decade. And for the first time, the focus is on the critical role of nurse assistants.

Democratic Assemblymen Kevin Shelley of San Francisco and Jack Scott of Altadena hope to upgrade the job with legislation to require more training, lighter workloads and more pay, which now averages $7 an hour. Shelley is seeking to increase that by at least 5%.

Even the nursing home industry--constantly hiring to replace the 80% of nurse assistants who quit annually--wants to get off the treadmill. A recent Los Angeles lawsuit alleged that one desperate nursing facility had recruited homeless people from Griffith Park.

"I don't think there's any argument from anybody that there needs to be more and better trained staff," said David Helmsin, who represents the California Assn. of Health Facilities and is the industry's top Sacramento lobbyist.

But there's a catch: The industry wants the state to pay for the added costs by increasing Medi-Cal reimbursement from $88 a day--among the nation's lowest rates. Industry estimates of $250 million to fulfill the bills' requirements far exceed the $35 million now earmarked in the Legislature's budget.

Nursing homes also oppose the additional penalties for poor care in Shelley's bill, including the quadrupling of fines to a maximum $100,000 when a death occurs.

Instead, they advocate an incentive system to reward homes that do a good job. They also support Scott's approach, which would force community colleges to train more nursing assistants--in fact, that bill was the industry's idea.

Troubled Work Force

Nurse assistants are high school dropouts and immigrants, single parents, foot-sore waitresses and unemployed construction workers. A minority are also college graduates and nurses in training.

The dozens who talked to The Times shared two traits: They were dog-tired and dead broke. Many work double shifts or second jobs.

Gloria Melara, 53, is supporting an ill daughter, four grandchildren and her parents in El Salvador. She works at an Inglewood nursing home from 7 a.m. to 3:30 p.m. and speeds to another facility in Playa del Rey to work from 4 to 11:30 p.m. By the time she arrives home in Huntington Park, she has just enough time to shower and sleep four hours.

"Sometimes your body says no, but you push it to go to work," said Melara, whose hip socket has degenerated so badly that her doctor recommends a hip replacement.

Nurse assistants' wages may average $7 an hour in California, but many make minimum wage, and years of experience don't necessarily count. After 21 years on the job, Melara makes $7.02 an hour at one facility, $9.42 at the other.

Administrators of nursing homes say that they cannot afford to pay more because Medi-Cal reimbursement--which covers two-thirds of California's nursing home residents--is so inadequate.

"Everyone agrees that more staff will result in an increased quality of care," wrote the administrator of a San Gabriel Alzheimer's center in a letter to Shelley. "However, all the regulations in the world will not increase staff and meet payroll. Only money pays payroll."

But reform advocates say that greed, not poverty, is the culprit, and they point to the multimillion-dollar compensation packages received by the nursing home industry's top administrators.

Los Angeles Times Articles