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."
Instead, the department consistently fails to deal with nursing care problems, elder advocates say. A year ago, when the Mission Villa home in San Francisco closed, the department was not on hand to make sure the facility followed rules regarding proper handling of the residents during the subsequent forced eviction. Last month, Daly City officials failed to adequately monitor the closing of a San Mateo home, Cole says. A year ago in Marin County, inadequate care at the Mill Valley Healthcare Center led to several questionable deaths. State Department of Health sanctions were minimal to nonexistent, public records show.
For its part, the California Department of Health says its Daly City office has been unable to hire enough employees, making it difficult to respond quickly to complaints. "It's not just some identified problems in Daly City; we've recognized problems in some other areas. We're looking at the issue of workload. There's a nursing shortage, so everyone is vying for the same bodies, including licensing and certification," says Lori McLean, acting chief for the northern field operations branch of the Health Department's nursing home Licensing and Certification division. Until recently, the Daly City office had six vacancies, McLean says.
To lessen the Daly City office's workload, Marin County nursing homes will be moved into the jurisdiction of the Department of Health's Santa Rosa office beginning next month, McLean says. Only San Francisco and San Mateo counties will remain under the Daly City office's purview, presumably giving the office a chance to handle complaints more quickly.
"I am aware that there have been some problems with the ombudsman about the Daly City district office. I have talked to the ombudsman about this and gotten back to them on specific issues. I have encouraged them to contact me so we can investigate those areas," says McLean.
As the Department of Health seeks to put its affairs in order, nursing homes continue behaving dangerously, advocates say.
Nursing Inn of Menlo Park just last month advised patients that the home was closing and that they needed to leave within a week. State law requires a 30-day notice for such evictions.
"It was over the holiday weekend. I think it should have been handled totally differently," says Mary Serafini, whose mother was a resident at the Nursing Inn. "I walked in there Friday and they told me they wanted my mother moved in a week. They said they wanted her out in a week, and I, like, panicked."
Financial adviser Robert Jacques told Serafini her mother had a legal right to stay 30 days, which Serafini says the home personnel eventually acknowledged. But not before putting Serafini through a scare.
Rose Silver, director of nursing at the Nursing Inn, denies that patients were given a week's notice, and says the patients were told all along that they had 30 days to vacate the premises.
"The notice was for 30 days, and we were prepared to be here for that period of time," Silver says.
There has been no report yet as to whether any of the residents suffered mental trauma as a result of the Menlo Park home closure. And the question of whether the Nursing Inn broke the law can only be resolved by a Department of Health inquiry.