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California:
Nursing homes criticized on medicine, food Tulare
Advance Register, May 19, 2003
California - Tulare County
nursing homes most commonly violate medicine and food-related regulations,
an analysis of Medicare records reveals. Of the 15 nursing homes in
Tulare County, 14 were cited for medicine-related deficiencies when they
were inspected last year by local and state regulatory agencies. Seven
were cited for food preparation deficiencies. The most common deficiency had
to do with drug use. Five homes were told to make sure residents who take
drugs are not given too many doses, that drug use is carefully watched and
that drugs that cause unwanted effects are discontinued and changed. Other common drug deficiencies
in Tulare County nursing homes included: ·
Failure to keep
accurate and appropriate medical records: four homes. ·
Failure to tell
residents, doctors and family members if there is a major change in
health: three homes. ·
Failure to provide
drugs and related services needed by each resident: three homes. ·
Failure to keep the
rate of medication errors to less than 5 percent: two homes. ·
Failure to keep
drugs and similar products locked safely and stored: two homes. ·
Making sure that
residents are safe from serious medication errors: two homes. "It's real easy to get
dinged on medication and nutrition, basically, because those are the main
functions of what we do," said Barbra McCling, director of operations
for Moyle's Central Valley Health. "They are very strict on us. "Most people are in
nursing homes because they need help with medication and food." Moyle's owns three nursing
homes in Tulare County -- Kaweah Manor in Visalia, Porterville
Convalescent Hospital in Porterville and Merritt Manor in Tulare. Six of the seven Tulare County
nursing homes cited with food violations were told to "store, cook
and give out food in a safe and clean way." Villa Manor Care Center in
Porterville was cited for three additional food violations, including
failure to provide three meals daily; to be sure residents were well
nourished and failure to prepare food that is "nutritional,
appetizing, tasty, attractive, well-cooked and at the right
temperature." McCling said that Moyle's has
developed a quality-control program for their nursing homes to help reduce
the number of deficiencies. She noted that the company's Merritt Manor in
Tulare decreased its deficiencies from 17 in 2001 to four in 2002, none of
them medicine- or nutrition-related. She said employees will
double-check each other by doing kitchen checks, surveying residents and
doing evaluations. "It's one thing to find
out you have a problem," McCling said. "It's another thing to
take the next step and solve it. I don't want to give an indication that
the other nursing homes are bad, it only means the staff did an excellent
job of self-monitoring and solving the problems." Prescott Cole, a staff attorney
for California Advocates for Nursing Home Reform, said the biggest reason
nursing homes continue to have deficiencies is because of the process of
correction. He said that a nursing home
will receive a deficiency, but then the only thing it has to do is write
up a report within 30 days to explain how it plans to fix the problem.
Sometimes, he said, someone from the licensing agency will come out to
verify the problem has been fixed, but not always. Also, he said, he believes the
homes should be receiving citations instead of deficiencies because they
are actually charged fines with a citation. However, most citations only
come after a serious problem that is a result of a complaint or incident. "Food is always an
interesting thing," Cole said. "The easiest place to cut back is
on food." He said that in his experience,
nursing homes that have deficiencies in food preparation are spending only
$3 to $4 per day on meals per resident. "These people aren't fed
well, even if the food gets to their mouth," he said. "That
shouldn't be a deficiency; that should be classed as elder abuse." Once a nursing home is found to
be in violation of federal standards, called a deficiency and ranked on a
12-point scale, it is subject to penalties ranging from fines to license
revocation. However, nursing homes are
rarely forced to shut down, said Charlene Harrington, a University of
California nursing home researcher. The problem: tight budgets,
inadequate staffing and weak political will. "We won't spend more money
to get decent staffing into these nursing homes and state survey
agencies," she said. Steve Pelovitz, director of the
survey and certification branch of the federal Centers for Medicare and
Medicaid Services, disagreed. "The purpose of our
oversight is to provide remedies and sanctions to try and help make sure
nursing homes have a set of incentives to get into compliance and remain
in compliance," he said. "This is not a system which at its
heart and core is one in which we look to decertify nursing homes or throw
them out." In the past three years, 5,637
fines have been levied against nursing homes, according to the most recent
data from the Centers for Medicare and Medicaid Services, the federal
agency that sets nursing home care standards. Even with all the information
on the Internet and through research, even analyzing one or two nursing
homes based on their deficiencies can be tough. "The statistics are easily
subject to misinterpretation," said Alan DeFend, public affairs vice
president for the American Health Care Association that represents 12,000
nonprofit and for-profit nursing homes and other long-term care centers.
"Drawing sweeping conclusions could present readers with an incorrect
picture of reality." Cole suggests
that those who are researching nursing homes should spend a lot of time in
the home, interview the residents and even sit down with the residents
during meal time. That way, he said, they will know how much and what the
residents are eating. Copyright
© 2002 Global Action on Aging
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