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Calif. Nursing Home Care Detailed

July 27, 1998

WASHINGTON (AP) _ Recounting tales of substandard care they believe contributed to the deaths of their loved ones, tearful relatives pleaded with senators Monday to keep closer tabs on the more than 17,000 nursing homes that care for millions of elderly Americans.

``I ask that you please stop and look and get more involved,″ said Leslie Oliva, who brought graphic photographs of bruises on the body of her 56-year-old mother, Maria Elena Espinoza. She died in March after spending time in three California nursing homes.

``The nursing facilities are stealing our ... money and not providing the right care-giving to our families,″ the Whittier, Calif., woman told the Senate Special Committee on Aging.

The committee more than a year ago heard allegations that thousands of patients had died in California nursing homes in 1993 because of malnutrition, dehydration, bed sores and infections. Sen. Charles Grassley, R-Iowa, the panel’s chairman, asked for an investigation, and scheduled Monday’s hearing.

In a report released Monday, the General Accounting Office, the investigative branch of Congress, said residents in 34 of 62 randomly sampled cases from California received care that was ``unacceptable and that sometimes endangered their health and safety.″

The report found such problems as inadequate intervention to prevent dramatic, unplanned weight losses and failure to properly treat bed sores that became infected and even toxic.

But, the GAO cautioned that without autopsy information, ``we cannot be conclusive about the extent to which this unacceptable care may have contributed directly to individual deaths.″

It also said weaknesses in federal-state oversight of nursing homes increase the likelihood that such problems escape scrutiny. It recommended, among other things, that required inspections of facilities be staggered to make such visits less predictable.

The federal government shelled out $28 billion in 1997 for nursing home care nationwide, $2 billion of it going to California through Medicaid and Medicare programs, GAO said. The nation’s most populous state has more than 1,400 facilities containing more than 141,000 beds, it said.

California officials declined to testify in person at the hearing, but in written testimony, the state’s health director, Kimberly Belshe, criticized the focus on California.

``Had this report compared California’s performance with other states, the GAO would have determined that California has been one of the most aggressive states″ in pursuing alleged nursing home abuses, she wrote.

In addition, Belshe criticized the focus on deaths in 1993, two years before legislation intended to improve federal oversight of nursing homes took effect. She also noted that new procedures for investigating complaints against nursing homes took effect July 1. The program includes criminal background checks for all certified nurse assistants and centralized nursing home licensure applications.

Paul Willging, executive vice president of the American Health Care Association, which represents many nursing homes, said numerous disorders and illnesses common among the elderly affect their willingness and ability to eat or drink. But he said the trade group has a ``zero-tolerance″ policy when it comes to abuse and neglect of the elderly.

Last week, President Clinton asked Congress to tighten oversight of nursing homes and said he would use his executive powers to require states to conduct more frequent and random inspections.

Clinton’s proposed legislation would create a registry of workers with a history of abuse and require nursing homes to conduct criminal background checks on new hires.

The administration also directed state enforcement agencies to impose immediate penalties on nursing homes that are repeat, serious violators. Enforcers now give them many chances to come into compliance.

The hearing was to continue Tuesday.