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"They finally carve out a niche, a home, and when they least expect it, an outside force demands that they move," Adamsky says. "This is disturbing for older people, especially for people who have been in the same environment for a while."
People like Astrid Lindman, a Swedish nanny who came to America when she was 55 years old. The former Chicago nurse's aide, the San Francisco I. Magnin employee who loved hats, who loved flowers, who grew up dreaming of living someday in the United States, had made a home at the Mill Valley Healthcare Center before it closed.
After she was forced to move, according to her daughter, Lindman found herself in a strange Colma nursing home which was not her home, and which she did not want to make her home. Lindman apparently decided to die.
"She stopped eating and drinking. She just shut down. She wouldn't interact with us. She completely shut down," says Agneta Lindman, a San Francisco hairdresser who immigrated from Sweden with her mother in 1962. "She kept saying 'This isn't my house.' " Lindman was 91 years old and heart failure was formally ruled the cause of her death.
Sheila McGorty monitors nursing homes as the long-term care ombudsman for the Marin County Department of Health and Human Services. McGorty believes that Lindman's was not the only death possibly connected to the closing of Mill Valley Healthcare Center.
Although confidentiality rules prohibit her from providing the patients' names, McGorty says she believes she watched other deaths from transfer trauma, and that as many as eight deaths can be attributed to the home's closing.
"One I witnessed, she was a very fragile senior, but very vital. She was very, very social. She would sit in the main room in the lobby and always greet people. She was 88 years old, but she was stable," McGorty says. "She had no medical conditions other than the fact that she was a fragile elder. I talked to her family and explained to them that ... if they did move her, she wouldn't live. That was her life at the Mill Valley home. She had no husband, no children, and she'd re-established the Mill Valley group as her second family. At the time of the evictions, members of her family were out on vacation. So the staff at Mill Valley moved her.
"I followed people as they moved. I followed her up to the new facility where she had been placed. She was in a corner room. I said, 'Do you want to meet some of the people here?' She didn't want to. She didn't want to eat lunch, and she went to bed. At dinner time, she didn't eat dinner. She curled up in a ball. I went in Monday, and she had died. She never got out of bed. A week later, the woman who had been across the hall from her was transferred and died."
For 30 years investigations by journalists, regulators, and advocates have chronicled a legacy of suffering in America's nursing homes. California has seen more than its share of complaints about inadequate staffing, improper use of medication, and in many cases, direct physical abuse.
A study by the federal watchdog General Accounting Office released last summer showed that one-third of the nursing homes in California had received citations for problems that endangered, and in some cases killed, patients. Federal and state officials all but look askance at the abuses, the report concluded. As a result, homes can cause patients to die, or suffer egregious harm, with little fear of serious repercussions from regulators, the report charged.
Indeed, for all of its failings in caring for patients at the Mill Valley Healthcare Center, Lenox Healthcare Inc. was fined a grand total of $1,000 by the state of California, for not having hot water, and the fine was waived.
Over the years, there have been myriad attempts at nursing-care reform -- there's one such battle going on right now at the Sacramento Statehouse -- but nothing ever seems to change.
Nursing homes have repeatedly been hit with lawsuits: Berkeley attorney William Taylor, who has made his living for the past 18 years suing old-folks homes, plans to file a class-action lawsuit against Lenox this summer over problems at the Mill Valley facility. (Although he initially agreed to talk with SF Weekly, Taylor changed his mind, and instructed his clients not to grant interviews.)
According to advocates for the elderly, things are likely to get worse. As the restructuring of the health-care industry turns nursing-home patients into commodities, firms are going to ever greater lengths to cut costs. As wave after wave of mergers and acquisitions sweep over the nursing home industry, care is becoming leaner by the year, says Pat McGinnis, director of California Advocates for Nursing Home Reform.
Mass relocations like the one at Mill Valley aren't rare either.
The Mission Villa nursing home in San Francisco, for example, decided this spring to stop providing care to Medi-Cal patients, and attempted to evict the low-income patients formerly under its care.
"There was no care plan, no transfer plan. They were dumped in the new facilities, and the new facilities were unprepared to deal with these people," says Prescott Cole, an attorney for California Advocates for Nursing Reform in San Francisco. "This kind of stuff happens a lot. The story just marches on. This wasn't an aberration."