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North Bay nursing home chain Ensign pulverized by watchdog report
By Joy Lanzendorfer
ONE OF THE hardest decisions anyone can make is sending a family member or loved one to a nursing home. While there are great facilities in the North Bay for the elderly and others requiring skilled nursing care, some North Bay nursing homes leave much to be desired, according to a scathing report recently released by industry watchdog organization Nursing Home Watch.
The report states that during the last year, three elderly residents at Summerfield Health Care Center in Santa Rosa have lost an alarming amount of weight. One patient lost 22 pounds in one month. Another lost 18 pounds in five months, dropping to 88 pounds. Family members said that when they brought her a sandwich from home, she "scarfed" it down and wanted more. When she was observed sitting in front of a puréed meal, the woman explained that the "food was cold and I do not like mushy food." A third resident lost 17 pounds in one month, dropping to 104 pounds. When an inspector saw her sitting in front of a dinner tray, crying and asking to go to the bathroom, a staff member said, "She always does that."
Last year at Santa Rosa's Park View Gardens nursing home, an elderly man was going to the bathroom unassisted when he fell and hit his head. The employee who looked at him said that he might have a head injury, yet no doctor was contacted until a full hour after the fall. The man later died from significant intercranial bleeding. Park View Gardens also had an outbreak of scabies last year that affected 55 residents and 36 employees. It was 15 days before health authorities were notified about the outbreak.
At the Sonoma Healthcare Center, a 79-year-old WW II veteran got a pressure sore on his heel. Though a doctor examined the heel, the staff was unable to provide documentation that they monitored or treated the wound. In 10 days, the pressure wound turned black and began to smell. The veteran was transferred to another nursing home, which reported that the infection had spread to his bone.
All of the problems cited in Nursing Home Watch's report occurred in homes owned and operated by Ensign Group, the fifth largest and fastest growing nursing home chain in the state. A coalition of unions and healthcare advocates, Nursing Home Watch (NHW) is highly critical of practices at Ensign's 26 nursing homes in California, including four in the North Bay, the aforementioned facilities as well as the Cloverdale Healthcare Center. The watchdog organization compiled data from official sources like Medicare, Medicaid and the California Department of Health Services that paints an unflattering portrait of the company.
"Overall, we found a very troubling patient care record," says Jennifer Kelly of NHW. "Some factors we saw were bed sores, low staffing levels, weight loss and unappetizing food. These are all dangerous signs."
The report claims that nearly all of Ensign's facilities are staffed below state levels and that the nursing homes were cited 314 times for violations in the last reporting period. Nursing Home Watch also filed a lawsuit against Ensign listing specific homes that have violated minimum-safe-staffing standards. Cloverdale Healthcare Center is included in the suit, the largest staffing-related lawsuit ever filed against a nursing home operator in the state.
According to state law, nursing homes must provide a minimum of 3.2 skilled nursing hours per day to each resident. The state average is 4.1 hours of care per resident. But state records for 2003 indicate that Ensign facilities were providing as low as 2.8 hours of skilled care to each resident daily.
Neglect was the most common problem in the 26 nursing homes. The report listed urine-soaked sheets, an unattended resident in a ditch outside a nursing home, open bed sores with exposed muscle or bone, and residents restrained or ignored by harried workers.
Outright abuse was less common, but the most disturbing allegation occurred at Sonoma Healthcare Center.
Ensign is not alone. Abuse of patients at other local nursing homes is an ongoing concern. Since 2002, Pleasant Care Napa has been fined a total of $55,000 by the Department of Health Services for allegations that improper care endangered the lives of three patients. The nursing home has filed several countersuits in Napa Superior Court to have the charges reduced or erased, according to the Napa Valley Register.
Separately, the state charged Pleasant Care Napa $1,000 because it said a 96-year-old resident was ill after the staff neglected to care for him. In addition, two residents witnessed employees assault a mentally impaired resident according to two former employees. Pleasant Care Napa didn't return calls from the Bohemian.
Low staffing ratios are one of the root causes of neglect in nursing homes.
"The key to proper care is an adequate number of staff," says Kelly. "If you have enough employees, you don't see problems like open wounds or residents falling because there are people there to assist them."
With a national nursing shortage, finding qualified staff is difficult for any healthcare organization. In the Ensign report, all four local nursing homes needed more nurses to reach the state's 4.1 hour average of daily care per resident, but some staff seemed unaware of the shortage. At Park View Gardens, which needs five more nurses to reach the minimum, an unidentified employee was indignant to questions about staffing levels.
"Boy, do you have your information wrong," she said. "We have more than enough employees."
Ensign says the report is an attack against the company because its employees aren't part of a union, specifically the healthcare workers union, SEIU Local 250. In a statement on its website, the company says that NHW claims to be "advocating quality care, but in reality they are just trying to punish Ensign caregivers and leaders for refusing to take union orders and pay union dues."
Ensign is a for-profit, privately held company founded in 1999 by longtime nursing-home operator Roy Christensen. Its strategy is to acquire struggling nursing homes and turn them around, cutting costs and increasing revenue. But a healthcare company with a for-profit status doesn't sit well with some.
"Ensign's mission is to make money," says Shirlee Zane, executive director of the Council on Aging of Sonoma County. "How they make money is by cutting back on patient care, staff, food, linen--all these things that are essential to healthcare."
Once a year, the California Department of Health Services makes a surprise visit to nursing homes for inspection. Facilities in violation are fined anywhere from $100 to $25,000.
"What's a little $1,000 or $10,000 fine to a company that makes millions in profit?" says Zane. "It's a ping on the wrist. It does nothing."
Ensign spokesperson George Stapley says that by being for-profit its employees can own part of the company and share in the fruits of their labor. Not all employees own part of the company, but many do. According to the report, the average hourly wage for employees in Ensign's 26 nursing homes ranges between $8 to $14 an hour.
Stapley adds that the data in the report does not take into account that the company is in the process of turning many struggling nursing homes around.
"Nursing Home Watch has consistently referenced the past operating histories of nursing homes that we have acquired just to make us look bad," he says. "It takes us 6 to 18 months to turn around a nursing home, and they are reporting data without acknowledging that."
But advocates for the elderly say that Ensign is merely trying to deflect criticism away from current care violations. These problems are essential to address, and not just because of health concerns.
"Bad care erodes morale, the emotional spirit," says Zane. "And that is essential in an elderly person who is frail or ill so they can survive."
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From the November 3-9, 2004 issue of the North Bay Bohemian.