Worst of the Lot

Bay Area nursing home regulation lags behind state

It is often said there was never a better time to be young and smart, rich and good-looking in the San Francisco Bay Area. This truth has a corollary seldom mentioned: There was never a worse time to be old, poor, and alone.

As mansions sprout along the hillsides of Mountain View and Palo Alto, nursing homes that serve the poor are closing in San Mateo, San Francisco, and Marin counties. Companies are finding more lucrative business in "assisted living facilities" that serve the wealthier and less-infirm elderly. This means there are fewer Medicare-eligible nursing home beds to go around. This in turn results in a situation where there is less pressure on remaining Medi-Cal-eligible nursing homes to provide the highest quality of care.

"They are opening these big fancy homes, while the smaller facilities that would take your lower-income elderly, they are just closing down," says Judith Guilfoyle, coordinator of a nursing home ombudsman program in San Mateo County.

When facilities shut down, they must follow strict state guidelines designed to prevent the kind of deadly trauma that afflicts the elderly when they are abruptly driven from their homes. Old people who are evicted without proper counseling and care all too often become disoriented and depressed, and die. Government oversight can also be crucial when nursing homes are in full operation. If the infirm elderly aren't turned or cleaned often enough, are fed improperly, or are given insufficient medical care, sores can become infectious, mild illnesses can become serious, and death can come much sooner and more painfully than it might have.

If ever there were a time and a place the role of government was evident, it is here, and now.

But Bay Area advocates for the elderly and local officials charged with monitoring nursing care say that our area is exactly where government oversight of nursing homes is at its very worst. They say the Daly City office of the Licensing and Certification division of the California Department of Health Services -- the office charged with inspecting nursing homes in San Mateo, San Francisco, and Marin counties -- may be the least effective in all of California.

According to state government data sorted by the San Francisco nonprofit group California Advocates for Nursing Home Reform, the Daly City office is, on average, tardier in responding to nursing home patient complaints than any of the 19 district offices in California's nursing home licensing program. In instances when the office is late responding to complaints, the total delay is, on average, much longer than similar delays at other offices around the state. California sets minimum quality of care standards for nursing homes whose patients are subsidized by the Medi-Cal health care program; the Department of Health Services is charged with enforcing those standards. But according to area health care officials, nursing homes in this area are policed by a derelict constable.

"The Department of Health Services a couple of weeks ago began investigation into complaints I had forwarded them in July," said Sheila McGorty, nursing home ombudsman for the Marin County Department of Health and Human Services, during an interview last week. "When things are allowed to go on and on and on, things become a pattern, and patterns become standard practice. The experience here has been for quite some time that there's a huge gap. There's an acknowledgement that the complaint has been received, but there is not a response."

A recent federal study shows there is plenty to complain about in California nursing homes. The report, released in 1998, showed that 34 percent of California nursing homes are so poorly run as to constitute a threat to the safety of their residents. Conditions had remained consistently bad during three decades, the report seemed to show. In 1977, the state-watchdog Little Hoover Commission issued a report saying a third of California nursing homes are substandard. The situation has been getting worse, thanks in part to nursing home closures, health care workers say.

Kevin Shelley, the former San Francisco supervisor who just became state Assembly leader, attempted to push through legislation last year that would have stiffened enforcement of nursing home regulations. But Gov. Gray Davis postponed promoting any nursing home bill until this summer at the earliest, lobbyists for nursing home patients say.

Peggy Goldstein, executive vice president of the California Association of Health Facilities, says the problem lies with the low fees Medi-Cal pays nursing homes to care for the elderly. Increased regulation only makes the difficult job of caring for the elderly harder, she says.

But advocates say that without adequate enforcement of existing laws, there is plenty of potential for abuse.

"A wink is as good as a nod," says Prescott Cole, attorney for California Advocates. "If somebody is complaining about a resident not being turned, and the facility does not change its care procedure, [the resident] will start to develop bedsores. If nothing is done, it will go to a bedsore as big as a fist down to the bone. If there's been a complaint, and if the Department of Health Services shows up, the facility makes the correction, and everybody's life improves."

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