Rays of Hope

Political winds may blow in long overdue nursing care reform

In January 1998, Janet Wright took her mother to a Peninsula nursing home to recover from surgery on a broken right heel. The recovery went slowly. By August, the 73-year-old music teacher was still suffering from what seemed like a mild infection when Wright left for a 10-day vacation at a rented condominium in Colorado.

Wright returned to face an unimaginable horror. She found her mother in a nearby hospital with a leg missing. Nursing home attendants had allowed the heel infection to advance into sepsis, a sort of infectious decay, then into gangrene, Wright says. They had ignored the woman's condition for about a week, despite the fact that the gangrenous flesh -- which produces an unmistakable smell similar to rotting meat -- had advanced across her leg as a swampy sore. The leg had to be amputated. Not long after, Wright's mother died.

"It turned out to be the nursing home from hell," recalls Wright. (Wright's name has been changed, at her request.)

The level of care Wright's mother received, unfortunately, is not uncommon in California.

Investigative stories chronicling the gulaglike conditions of some nursing institutions are a perennial staple of daily journalism. A federal report released last summer found that 34 percent of California nursing homes are so poorly run as to constitute a threat to the safety of their residents. The report indicated that little had changed since 1977, when a report by the state watchdog Little Hoover Commission concluded that one-third of the state's nursing homes were substandard.

Now, nursing care advocates in California believe a window of opportunity may be opening, finally, to improve the state's institutions for the elderly.

Patient advocates say last year's political earthquake, which gave Democrats firm control of the Statehouse, could lead to improvements in the care afforded the elderly, and particularly the elderly poor.

Back when he was an assemblyman, Gov. Gray Davis sponsored bills promoting elderly rights. And Kevin Shelley, the former San Francisco supervisor who is now state Assembly leader, has pledged to wage a campaign for nursing patients. As America's population grows older, issues such as nursing care will receive greater attention from politicians, advocates say.

"It really is going to be a huge, continuing issue," Shelley said during an interview. "I'm going to fight like hell, because I think it's important."

Shelley is now sponsoring a bill that would increase the fines nursing homes pay for neglect and abuse, increase enforcement of nursing care laws, and require a higher ratio of staff members per nursing home patient.

Things can only get better after eight years of Gov. Pete Wilson, patient advocates say. Lax enforcement under Wilson's administration, they claim, allowed abuse at care facilities to flourish. Aggressive lobbying by the California Association of Health Facilities, Shelley says, kept the sword of threatened veto hanging over every piece of nursing care reform legislation that was considered during Wilson's eight-year tenure.

In addition, a U.S. Department of Justice survey found, former state Attorney General Dan Lungren won just 10 convictions out of 515 nursing home patient abuse and neglect cases prosecuted during 1996.

The state Department of Health Services, which licenses nursing homes, has not responded aggressively to complaints of abuse and neglect, adds Patricia L. McGinnis, executive director of the San Francisco group California Advocates for Nursing Home Reform.

Only last month, for instance, did the department's Daly City office finally begin investigating Janet Wright's November 1998 complaint about her mother's treatment. And that investigation began only after McGinnis went to Sacramento and showed a photograph of Wright's mother's leg wound to Health Services supervisors.

"It wasn't until I went up to the Department of Health Services headquarters in Sacramento, and took a copy of the complaint, that the office in Sacramento directed the Daly City office to investigate," McGinnis says. "All I had to do is take this picture up and show it to people in Sacramento."

Inspectors at the Department of Health Services' Daly City office did not return a call requesting comment.

While the political climate may be changing, it remains far from certain how much things might improve. Just as current political trends seem to be stacked in patients' favor, economic trends seem to be allying against them.

A fierce wave of mergers and acquisitions in the nursing home industry has led to ever greater attention to profit margins -- and less attention to quality of care, McGinnis says.

"As long as we have the for-profit chains dominating nursing care, we're not going to have good care. The bottom line is going to be return on investment," McGinnis says. "There have been more mergers and acquisitions in the last two years than in the history of nursing homes in California."

While the Clinton administration is pushing its own nursing care reform package, which includes $4 million to beef up enforcement, that may not be much help, says California Advocates for Nursing Home Reform attorney Prescott Cole, since the new money must be parceled out across the entire country.

While California demographics may be shifting toward the elderly, meanwhile, the poor folk who populate Medi-Cal-funded nursing home beds aren't exactly at the center of gray-power politics. Pat Luby, Sacramento lobbyist for the American Association of Retired Persons, for instance, says his organization is focusing its energy on pushing to require nursing homes to display a Michelin Guide-style rating system in order to help consumers choose quality care.

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