More than three-quarters of California nursing homes fail to meet federal standards, and more than four in 10 homes violate a state law mandating minimum nurse-staffing levels, according to a comprehensive review of the state's nursing-home quality.
The 32-month study by the nonpartisan California HealthCare Foundation also found tremendous instability in the work force: Nearly eight in 10 nursing staff members left their jobs from 2000 to 2001.
At the same time, the foundation has launched a Web site that provides detailed information on all 1,406 nursing homes in the state. The site, www.calnhs.org, compares their performance on specific measures (such as nursing staff turnover) by assigning stars, with one star representing the worst homes and three the best.
Taken together, the study and the Web site represent the most ambitious effort in California to measure the quality of nursing homes and to spur improvement. Before now, information on such homes was limited, scattered and sometimes left families choosing haphazardly.
"I was surprised that things weren't better than they were," said lead researcher Charlene Harrington of UC San Francisco's School of Nursing. "We just found a lot of quality problems in the nursing homes. It's really pretty depressing."
The foundation review arrives amid a broad push for greater accountability from nursing homes, which house more than 100,000 Californians and generate $5.6 billion in revenue each year.
State Atty. Gen. Bill Lockyer has sought to penalize problem homes, filing 131 criminal complaints in the past fiscal year.
"The quality of care in many of our state's nursing home facilities is reaching a level of crisis," said Collin Wong, director of the Bureau of Medi-Cal Fraud and Elder Abuse within the attorney general's office.
"The same corporate culture and ethics that led to Enron, Worldcom and Arthur Andersen's demise is no less present in the corporations that own and operate our nursing homes."
On Tuesday, hours after the foundation released its report, state health officials announced their own three-step program to improve nursing-home care. The plan involves expansion of a statewide consumer assistance center, increased monitoring of nursing homes and higher financial penalties for violations.
Next month, the U.S. Centers for Medicare & Medicaid Services will launch a nationwide quality initiative, paying for full-page newspaper ads to publicize how the largest nursing homes in each region score on such measures as controlling patient pain and preventing bedsores.
