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Nursing Home Problems Persist Despite Increased Funding

Casper, Meadows, Schwartz & Cook

In California, nursing home care can pose a serious problem for elderly residents and their families. Despite significant governmental efforts to improve care by providing additional funding for nursing homes, many homes have cut staff and decreased wages - thereby leading to concerns over the quality of care.

Patient advocates argue that staffing deficiencies commonly leads to neglect, which is the primary cause of injuries in nursing homes. Nursing home providers argue that they do not have the income to pay the wages necessary to attract quality caretakers so that staffing issues do not lead to injuries.

Nursing Home Quality Care Act of 2004

Lawmakers in California took notice of this problem and passed the Nursing Home Quality Care Act of 2004. The law was designed to attack two major nursing home issues: staffing needs and MediCal reimbursement. With more money at their disposal, legislators believed that nursing home operators would be able to hire more staff members and care for more medically fragile patients. Prior to the new law, MediCal reimbursement was $124 per day. Afterward, nursing homes could be reimbursed $152 per day for the same type of care.

However, a number of studies and investigations found that many nursing homes did not use their new income to increase staffing or their standard of care. An investigation by California Watch found that 232 nursing homes either cut staffing, paid lower wages, or let caregiver levels slip below state-mandated minimum levels. California Watch also found that of the 131 homes that reduced staffing, the median income was 35 percent higher than other homes that maintained staffing levels. Dozens of homes operated below the state minimum standard established in 2000, which was set at 3 hours and 12 minutes of caregiver attention for each patient per day.

Unintended Consequences

While the funding increases were intended to curb nursing home complaints and statutory violations, both increased. Before the new law was enacted in 2004, there were 4,499 complaints against nursing homes. In 2008, there were 5,549 - an 18 percent increase.

Serious injuries also became more prominent despite increased funding. At Applewood Care Center in Sacramento, an 84-year-old passed away when she fell down a flight of stairs in her wheelchair. About a half-hour passed before staffers found her still strapped to her wheelchair. An 89-year-old woman was sent to the emergency room for severe dehydration. Eleven days later, she was sent back to the hospital for the same dehydration issue. Another man died when he choked on a piece of food. Applewood was fined $100,000 for the wheelchair incident, $20,000 in the dehydration case and $100,000 in the man's death.

Using Additional Funds for Legal Fees

A further issue, nursing homes also began using their increased funding to fight claims of inadequate care. Essentially, they were able to bill the state for legal costs incurred in defending lawsuits and challenging citations. Michael Connors, an advocate for California Advocates for Nursing Home Reform, explained that the law resulted in the state subsidizing the mistreatment of patients by allowing nursing homes to bill for their legal costs. Elena Alquist, a state senator from Santa Clara, said "In this fiscal environment, where the state has no money and all of this is coming out of the taxpayers' pocket, yours and mine and everyone else's - this is really unconscionable."

Legal Remedies

Despite the unintended consequences of the funding law, patients injured through abuse and neglect still retain the right to seek money damages. Elders and dependent adults are afforded a special status under the Elder Abuse and Dependent Adult Civil Prevention Act (EADACPA). Under this law, an elder or a family member may bring suit against a nursing home or long-term care provider to recover past and future medical expenses, lost wages as well as punitive damages. In cases where an elder has passed away, family members may also recover damages for lost comfort and care the elder would have provided, as well as attorney's fees, in addition to medical expenses and lost wages.

It remains to be seen whether the legislature will continue to allow reimbursement for legal fees incurred in matters where the nursing home was found to be at fault. Nevertheless, it is terrible that nursing homes would take additional funding, ostensibly to improve services, only to take advantage of society's most vulnerable people. If someone you love has been harmed in a nursing home, contact a lawyer.