Fatal Lapses in Rest Home Care Cited

SAN FRANCISCO — Fourteen residents of California nursing homes died last year because of mistakes or misconduct by the facilities, an advocacy group said Wednesday in a report that calls institutional care of the state’s elderly a tragic disgrace.

Another 379 patients were in “imminent danger” of death or serious harm as a result of violations by the homes in 1992, according to the report by the nonprofit California Advocates for Nursing Home Reform.

In one case, a resident of a Merced nursing home died by choking after being force-fed. In another incident at a Davis convalescent center, a patient was killed by “fecal impaction” caused by drugs that caused constipation. And in a third episode, a Riverside patient prone to falls died after tumbling from her wheelchair.

State fines for these violations ranged from $10,000 to $25,000 and have been contested by the homes. In hundreds of other incidents, patients were needlessly or excessively drugged, restrained in their beds for days and forced to lie in their own feces, charged the report, which was based on government inspection and citation records.

“People are suffering and losing their lives because this industry tolerates substandard care,” Patricia McGinnis, executive director of California Advocates, said in releasing the study. “If these sorts of abuses were happening to animals, we would be outraged. Why don’t our elderly get more respect?”

An industry spokeswoman reacted hotly to the report, saying it distorts the picture of nursing home care, which she described as “quite good, overall.”

“There are individual situations where residents and families are not pleased,” said Kathy Daigle of the California Assn. of Health Facilities, which represents 1,000 nursing homes. “But if there are legitimate problems, there is a rigorous enforcement system to deal with them.”

Daigle declined to discuss the 14 deaths, noting that many of those cases are in litigation.

According to the study, a majority of California’s 1,228 rest homes fail to meet acceptable standards in certain categories of care and lag behind the national average in compliance with federal laws.

The report also faulted government’s enforcement approach. In 1992, it noted, the state issued 1,812 citations to nursing homes and assessed about $5.6 million in fines. But in keeping with the enforcement philosophy, many of the fines were forgiven once they were appealed or problems were corrected, so only $2.3 million was collected.

State regulators acknowledged the past enforcement trouble but said a new law that went into effect Jan. 1 has brought improvements. In the first five months of this year, the state has levied $1.3 million in fines and collected $550,000 of that total.

In one area--the use of drugs and physical restraints to control patients--the report found that California’s rest homes have made progress. In in 1992, 26% of all patients were restrained, down from 68% in 1990. Still, California lagged behind the rest of the nation in reducing the use of such restraints, federal data contained in the report shows.