Rochester Democrat & Chronicle - May 18, 2003

Study unveils deep flaws in U.S. nursing home system
Larry Wheeler and Robert Benincasa, Gannett News Service

(May 18, 2003) - WASHINGTON - Where a nursing home is and who owns it can be
critical in determining the care given to America's most frail and
vulnerable, a Gannett News Service investigation has found.

Nearly three-fourths of the most severe and repeated nursing home patient
care violations found in the past four years were concentrated in a dozen
states -- New York was not one of them. Additionally, patients at homes owned
by for-profit companies fared worse in some ways than residents in government
and nonprofit nursing homes.

"There are many flaws in the long-term care system," said Thomas Scully,
administrator of the Centers for Medicare and Medicaid Services, which
directs federal nursing home programs. "We're trying to look at them and fix
them."

The findings are the result of a four-month Gannett News Service
investigation. GNS interviewed dozens of people and analyzed four years worth
of federal data on inspections and patient well-being at the nation's 16,000
nursing homes.

The analysis revealed significant weaknesses in the safety net designed to
protect the nation's 1.5 million nursing home residents, weaknesses not
apparent on a nursing home quality Web site the federal government created.
Star ratings for each Medicare- and Medicaid-certified nursing home, the vast
majority of nursing homes nationwide, can be found in a GNS searchable
database on the Internet. The analysis also ranks each home's inspection
results against peers in its home state.

Most of the 618 inspection reports for Monroe County's 36 nursing homes
identified isolated problems. Only 12 reports noted problems that were
considered widespread and potentially dangerous. Those deficiencies were
later reported as being corrected.

Some national findings:
For-profit nursing homes accounted for 83 percent of the more than 500
nursing homes with repeated, serious violations, yet are only 65 percent of
all Medicare- and Medicaid-certified nursing homes.
Patients at for-profit homes had, on average, higher rates of infections and
pressure sores than those the government and nonprofits own.
Homes monitored by councils of residents' family members tended to have a
higher use of physical restraints and a lower rate of patients in pain.

Information about nursing homes and the care they provide is crucial to
thousands of Americans who each year must confront the difficult decision of
placing a loved one in a long-term care center.

As a nurse, Anne Smith of Salt Lake City is well aware of the troubled past
and present of nursing homes. When she needed care for her 88-year-old mother
who was recovering from a heart ailment, she asked the hospital discharge
planner for help. The planner handed her a list of 31 nursing homes in the
area.

"I said, 'Can you help me find a good one?' and she said she wasn't
allowed. And to tell you the truth, she probably didn't know which ones were
good or bad," said Smith, 65.

Smith turned to a new consumer-oriented tool on the Internet, the federal
government's Nursing Home Compare Web site, which lists residents' health
status and inspection results for all Medicare- and Medicaid-certified
nursing homes.

The site is part of the federal government's major new nursing home
initiative, which spent about $30 million to draw attention to the Web
project. It features inspection and patient health results for every nursing
home in the country.

Another $1 billion was pledged over three years to expand the role of quality
improvement organizations, staffed by health care professionals, that work
with nursing homes to lift the level of care delivered to nursing home
patients nationwide. With a list from the Web site, Smith narrowed her
choices, using proximity to her home and other factors.

"It helped me go into the nursing home with this information and ask them,
'What is your strategy for caring for my mother because you don't look very
good on paper,' " Smith said.

Weak laws

Consumer advocates who reviewed the GNS findings said they were not surprised
that the investigation found a substantial number of repeat violations and
links between poorer care and for-profit ownership.

They say nursing home residents continue to suffer from neglect and abuse
despite new quality and information efforts and years of legislation and
regulation intended to protect patients.

The National Citizens' Coalition for Nursing Home Reform recently published a
book depicting in graphic, heart-wrenching detail the neglect and pain 82
Texas nursing home residents suffered. The coalition is the nation's largest
consumer advocacy group focused solely on nursing homes.

An example:
Lunnie C., 93, entered a Longview, Texas, nursing home suffering from a
handful of ailments that included coronary artery disease. Twenty months
later she was taken to the hospital suffering from deep pressure sores, more
commonly known as bedsores; dehydration; malnutrition; and gangrene in her
left foot. State inspectors found the nursing home staff had neglected her.

Incidents like this continue to occur despite government officials' claims
that care in nursing homes is improving, said Donna Lenhoff, the coalition's
executive director.

"These are severe breakdowns in the provision of health care services and in
the provision of basic human decency," she said. "There are a lot of nursing
homes that are giving a lot of bad care."

Trouble spots

Nearly three-fourths of severe and repeated violations of federal patient
care standards from 1999 to 2003 were at nursing homes in 12 states. They
are, in descending order: Texas, Illinois, Arkansas, Washington, New Jersey,
Kansas, Missouri, Indiana, Oklahoma, North Carolina, Mississippi and
Tennessee.

The violations included failing to protect patients from mistreatment, hiring
staff without conducting criminal background checks, and allowing patients to
be abused and physically punished.

In some cases, problems were isolated. But in others, dangerous conditions
were widespread.

"These reports represent a snapshot in time, so in that sense, the data is
somewhat limited," said Sandra MacWilliam, president of continuing care
services at Unity Health System, which operates three nursing homes in the
Rochester area. "But it is another way for consumers to measure quality, and
that can be helpful."

The best thing family members can do when inquiring about nursing homes is to
visit the facilities and question the staff and residents about the level of
care there.

That's exactly what Greece resident Sylvia Willard did a few years ago when
she decided that her 68-year-old husband, who suffers from dementia, needed
to be in a nursing home. Willard toured various nursing homes and interviewed
their employees and residents before settling on the Edna Tina Wilson Living
Center in Greece.

It was a daunting challenge, though. Unaware of government inspection reports
that might have been available to the public, Willard, 62, said she placed
her trust in the people that she talked to.

"Having all this information computerized I'm sure is a good idea," said
Willard, who remains satisfied with her decision to go with the Greece
facility.

Includes reporting by staff writer Matt Leingang.

On the Web

Gannett News Service Special Report: Rating America's Nursing Homes at:

http://content.gannettonline.com/gns/nursinghomes/

The report features an online database that allows readers to search the
nation's 16,000 nursing homes for ones near them or their family members.