State investigators fail to provide oversight
The Contra Costa Times had a good article from the Oakland Tribune's review of records from California's Department of Public Health which is the watchdog that oversees the quality of care in California nursing homes. They have allowed facilities to continue operating despite serious problems that persisted over years, a review by the Tribune revealed. Consistent problems include urine-soaked mattresses, festering bedsores, patients lying in feces or restrained in wheelchairs without supervision.
In some cases, operators were able to hide a pattern of problems by changing the names of their companies or their facilities after they were cited by the state or sued. In other cases, records show that regulators were aware of the care centers' history of noncompliance but licensed them anyway. The department has been accused numerous times of not enforcing the state's own laws. It has been sued for taking years to respond to complaints about abuse and neglect, as well as for not requiring state-mandated staffing levels at facilities. One lawsuit claimed that the department's lack of oversight was contributing to poor care residents received at facilities.
Unchecked neglect and abuse was at least one factor that drove Diana Harden to walk into an Oakland nursing home last month and shoot her disabled daughter and then kill herself, according to a letter Harden wrote to KGO-TV ABC7 News before the Sept. 13 murder-suicide. Harden asserted that her brain-damaged daughter, Yvette Harden, was mistreated and neglected at the Oakland Springs Health Care Center on 10th Avenue, where she had been a patient for six years.
Between 2004 and the September murder-suicide, Oakland Springs received more than 152 complaints and 212 deficiencies, many of them serious. But the state took no enforcement actions. Instead, the facility was required to submit a plan of correction and largely expected to enforce its own compliance with the plan, according to Department of Public Health records.
Annual inspections are the principal tool the Department of Public Health uses to monitor the quality of care in nursing homes. If significant problems are found during surveys or when inspectors investigate complaints, the facility can lose its contract with Medi-Cal and Medicare. That poses a considerable threat to many homes because the two federal programs pay for the majority of all long-term resident care. But in 2006 the department was so behind in investigating complaints that a judge required it to improve its oversight of nursing homes and submit quarterly reports showing that investigators were addressing complaints on time — within 10 days, or 48 hours when the complaint involves imminent danger to the resident.
In one case, an 87-year-old man's wound became so infected that his leg had to be amputated in 2005 despite numerous complaints from his family to the department from the time the wound began to fester. Shortly after the amputation, he died of multiple causes including widespread infection.
In another case, a woman suspected her mother's October 2004 death had to do with her treatment at a nursing home and complained to the department. Inspectors took seven weeks to arrive at the Los Gatos facility, Terenno Gardens Extended Care. They also took more than a year to investigate the death of a patient at a nursing home whose bedsores had become infected. In the meantime, another resident of the same home developed severe bed sores. An on-site investigation was not conducted until a year after the complaint was filed.
With each day that passes, the chance of properly investigating and redressing violations diminishes. Instead, the delay means the complaint is more likely to be unsubstantiated because the residents, witnesses and evidence may no longer be available. Then in 2007, the California state auditor criticized the department for not correctly prioritizing complaints, too often understating their severity and not completing investigations. The auditor criticized the agency's policy of waiting for a nursing home to submit a plan of correction before informing caregivers of the investigation results. The auditor also found that the system used to track complaints is subject to error, the disbursement of funds is suspect, and the timing of nursing home inspections is predictable, allowing some facilities to hide violations.
The Department of Public Health claimed that a lack of qualified evaluator nurses was behind the backlog of complaint investigations, which stretched into the previous decade. That demand is expected to grow more severe as the number of baby boomers move into retirement age — 78 million by 2030, according to the Institute of Medicine. Already there are 1.5 million Americans in nursing homes. Without tough oversight, operators can continue to rack up deficiencies while residents suffer.
In 2005, federal surveys found that California surveyors missed at least 25 percent of serious deficiencies. They are overlooked, a 2005 Government Accountability Office report said, because surveyors often are confused about what poses an imminent danger, such as worsening, avoidable pressure sores and untreated weight loss — frequently signs of understaffed facilities with poor quality of care.
In addition, surveyors across the country reported being asked by superiors to overlook or downgrade survey findings, the GAO said. These problems distort the system of accountability for negligence and put residents at risk, said Carole Herman, founder of Foundation Aiding the Elderly. She sued the state Department of Public Health in 2006 because the agency still had not issued regulations that required nursing homes to provide each resident an absolute minimum 3.2 hours of skilled nursing care on a daily basis three years after the agency developed the staffing law.
Meanwhile, medical errors at Oakland Care Center mounted, employees complained they had to use their own money to buy supplies, and there were 72 deficiencies and 34 complaints between 2004 and 2009, Public Health Department records showed.
