TJ Sullivan is a literary author, investigative journalist, photographer and college instructor whose work has been published in a myriad of newspapers and magazines, including the Los Angeles Times, Chicago Tribune, and The Detroit News, the latter of which he delivered while working as a paperboy during his childhood in the City of Detroit. Sullivan's writing has received many top national honors, including the Sigma Delta Chi Award, the second oldest journalism award in the United States after the Pulitzer Prize. Other state and national accolades include first-place awards from Best of the West, the American Association of Sunday and Feature Editors, the Associated Press News Executive Council and the Los Angeles Press Club. In 2006, Sullivan was commissioned a Kentucky Colonel, the highest title of honor bestowed by the Commonwealth of Kentucky, the home of his alma mater, the University of Kentucky. Sullivan's years as a full-time newspaper reporter were spent at several esteemed publications, including the Santa Fe New Mexican, The Albuquerque Tribune, and the Ventura County (CA) Star. Sullivan has also written for NBC Universal, The Dallas Morning News and the preeminent public affairs website LA Observed. Sullivan is frequently sought as an informative and entertaining speaker on the craft of writing, the art of investigative reporting, and the intricacies of state, county and municipal government. His presentations have been featured at professional development conferences conducted by both The Poynter Institute and the national Society of Professional Journalists. Sullivan has taught journalism courses and coached writers at UCLA's award-winning student newspaper, The Daily Bruin. He has also taught as a part-time faculty member in the Journalism Department at California State University, Northridge. And, in 2006, he was an adviser to SPJ's The Working Press, an internship program for college-level student journalists. Sullivan is currently at work on his third novel, [working title "Howard is Home from The Loop"]. He lives in Chicago, Il.
Complaints about nursing homes
can sit for months
Lack-of-money excuse is disputed
By TJ Sullivan
Ventura County Star
The California Department of Health Services is delaying the investigations of many complaints filed against nursing homes, a situation industry watchdogs say endangers the lives of society's most vulnerable elderly citizens.
Officials with the department confirmed recently that the state's 700 inspectors, 15 of whom operate out of the Ventura District office, have been directed to reprioritize workloads, resulting in delays of up to a year for what would otherwise have been done within 10 days.
Robert Miller, a spokesman for the Department of Health Services, said the change was communicated to employees in the form of a "verbal directive" this past fall and was not put into writing. He said the action followed "funding reductions" that resulted in the loss of 70 employees, or 10 percent of the staff that conducts investigations.
"We're not ignoring any of that workload," said Denise Arend, assistant deputy director for licensing and certification in the Department of Health Services. "We're just managing it a little more carefully."
Arend said the change does not affect complaints involving imminent danger of death, which will continue to be investigated within 24 hours.
Nonetheless, industry watchdogs such as Pat McGinnis, the founder and executive director of California Advocates for Nursing Home Reform, say the change in response time is a "great cause for alarm" because some of the complaints could eventually lead to severe injury or death.
"It's not knowing how to put in a feeding tube and puncturing a lung," said McGinnis. "It's allowing people to lay in their own feces or urine until a horrible bedsore erupts."
Eric Carlson, a lawyer specializing in long-term care with the National Senior Citizens Law Center in Los Angeles, agreed.
"If you don't respond for weeks and weeks, subsequently it's not going to be a surprise when the complaint is not substantiated because the evidence is gone, the records are gone, memories are fading," he said. "Eventually it becomes an exercise in futility."
McGinnis said the matter is complicated further by an 80 percent annual turnover rate among the certified nursing assistants, also called CNAs, who care for those who live in nursing homes. In some cases, she said, a nursing assistant who witnessed an incident may have moved on to a second or third job by the time a surveyor turns up months later to investigate a complaint.
Still waiting for inquiry
Lauretta Masters, a San Fernando Valley resident whose father was a patient last year in a Ventura County nursing home, said she was still waiting for the state to investigate an injury her father suffered when he fell out of his bed in July 2003.
The broken hip he suffered in that fall took the facility three days to diagnose, she said.
Masters said it took six months for a representative of the state Department of Health Services to call her after she filed her initial complaint, which she turned over in mid-July to the long-term care ombudsman in Ventura County, a federally mandated office that fights for the rights and needs of nursing-home residents. An official with the ombudsman's office said the complaint was passed on to the state on July 14, immediately after it was received.
Masters' father, an 82-year-old who suffered from dementia, died in November, four months after she registered the complaint and two months before an investigator contacted her.
"I work for the federal government and our system's pretty slow, but something is wrong with this one," she said. "I can't believe it's eight months. My father has passed on, but I want to follow through. Who knows, maybe there's 10 other people who have been hurt since then. That's not right. They need to do something about this system."
Department of Health Services officials say they do not believe care at nursing homes in Ventura County has suffered because of the delay in investigations.
"I don't see any trends on eroding levels of care," said Lana Pimbley, manager of the Ventura District office for the Department of Health Services.
The issue of delaying investigations is not new and certainly not limited to California.
Testifying in 1999 before the U.S. Senate Select Committee on Aging, Mike Hash, deputy administrator of the federal Health Care Financing Administration, said: "The General Accounting Office ... found that states do not always investigate these complaints promptly, or at all. Therefore, effective immediately, any complaint that alleges actual harm to an individual in a certified facility must be investigated within 10 working days of its receipt."
The California Health and Safety Code echoes that requirement, stating that complaints involving "a threat of imminent danger of death," otherwise referred to as "priority one" complaints, must be investigated on site within 24 hours.
All other complaints are labeled "priority two," and the law says they should be investigated on site within 10 working days, unless the complaint is determined to be unreasonable, in which case it can be dismissed.
"It would be ideal to get there within 10 days ... but that is not the way it's working right now," Pimbley said.
Instead, it's possible that the investigation of priority two complaints could be put off for more than a year.
"Right now they're being held until we can go out at the next scheduled survey," Pimbley said. Scheduled surveys are done once every nine to 15 months.
"This came as a directive from headquarters, so it's a whole new shifting of workload," she explained.
But Ken August, a spokesman for department headquarters, said only about 15 percent of the priority two complaints this year have been delayed until the next survey. The rest, about 85 percent, have been taken care of within the 10-day requirement, he said.
"It's a goal that we strive to reach every day, and do our very best to achieve," August said.
Arend said the department receives "roughly" 20,000 to 30,000 complaints a year.
The department was unable to produce statewide data showing actual complaint and citation totals for the past five years. As a result, officials could not say whether complaints have increased or decreased.
The problem, Arend said, is that the department's computer system is antiquated, which makes it difficult to extract such numbers in a timely fashion. She said the department doesn't have the dollars necessary to track trends regularly, even though doing so could alert the state to deficiencies in areas such as the training of nursing assistants.
Agencies outside of state government have had more success tracking the state's data, and they say the tale the numbers tell is a startling one.
A report released in November by the school of nursing at the University of California revealed that complaints increased 38 percent from 2000 to 2002. But perhaps most notable in the report was the 65 percent increase it found in the number of complaints that were deemed "unsubstantiated" by the state Department of Health Services.
Ventura County saw a similar trend, according to data compiled by California Advocates for Nursing Home Reform. CANHR's numbers indicated that unsubstantiated complaints in Ventura County went up 40 percent from 2000 to 2002, while substantiated complaints dropped by the same percentage.
Charlene Harrington, a professor at the University of California, San Francisco, who co-authored the university's report for California Nursing Home Search (http://www.calnhs.org), said the dramatic rise in unsubstantiated complaints could be the result of delayed investigations.
"We suspect it's because they don't get out there in a timely way," Harrington said. "If they don't get out there fairly soon afterward it's sometimes hard to substantiate."
Bruises can heal in the time it takes for a surveyor to show up. Staff can relocate. Patients can die.
"The average complaint was not completed until one to three months after the due date," Harrington said.
But Betsy Hite, director of public affairs for the California Association of Health Facilities, a nonprofit trade organization that represents nursing homes and homes for the developmentally disabled, reacted viscerally to the suggestion that the complaint statistics indicated anything but improvements in the quality of care.
"I think we're seeing less of an adversarial relationship between surveyors and providers because the surveyors do understand this system and that the services that are being provided are being provided rather heroically," Hite said.
She also cited a recent report conducted by Health Grades Inc., which markets such data to the healthcare industry as well as investors and insurance companies.
"They come up with the 10 best and worst cities for nursing home care in the United States," Hite said. Quoting from a report released in 2000, Hite said six of the top 10 best cities for nursing home care are in California. The top city was Los Angeles.
"We were thrilled," she said.
Cliff Robertson, an 81-year-old resident of Victoria Care Center in Ventura, brushed the surface of his thumb back and forth across each of his fingertips as he offered his opinion of the nursing home industry.
"I think I could sum it up in a nutshell when I say all care centers are out for one thing," he said, his fingertips expressing the universal hand sign for money as he sat in his wheelchair.
Some say the money is a big part of the problem, particularly with regard to the hourly pay rate of nursing assistants, who average about $10 an hour.
More money, more care
"Even though the nursing home industry will always, always, always say, 'Give us more money and we'll give you more care,' it doesn't necessarily happen," said McGinnis. "Corporate chains don't take their money and put it back into their facilities, or staffing, or the structure. They give it back to the investors."
Hite disagrees and says the cost of care is to blame.
"The Medi-Cal rate, at $110 a day, works out to $4.99 an hour ... I don't know where you can get a baby-sitter for $4.99 an hour," she said. "And yet we're supposed to provide care."
Regardless, critics say some facilities charge much more than what is paid by Medi-Cal and yet still provide low pay to nursing assistants.
Hite confirmed that turnover among nursing assistants is close to 80 percent, a situation that complicates the ability of facilities to maintain well-trained staff.
A review of citations against several Ventura County facilities revealed that many concern the actions of nursing assistants who didn't follow proper procedures.
In one 1998 case, a 77-year-old man who suffered from dementia was left alone seated beside open containers of detergent-disinfectant after he asked a nursing assistant to get him something to drink.
While the assistant was getting him water, she heard the man cough and drop one of the containers. The citation report says the man told the nursing assistant that he had just drank a "cool (sic) aid drink and it was not good."
He vomited immediately and later that evening complained of headache, nausea, vomiting and a burning sensation in his throat and stomach. Six days later, a nurse's report said he developed an open blister in his mouth.
Although the patient's physician and family were notified, the Department of Health Services was not.
The $10,000 penalty that is usually assessed for such a Class A violation was tripled to $30,000, according to the citation.
As the state of California prepares to make even more drastic budget cuts, the Department of Health Services realizes further reductions are possible.
"We are concerned as a program, as are many other agencies, about how it is we are going to continue to do the work and meet the expectations," Arend said. "We are just keeping watch on all of the work and where the priorities are and just carefully managing our resources."
The office of the long-term care ombudsman for Ventura County said it had already increased its efforts to pick up the slack, no easy task for a staff of five complemented by 50 volunteers.
"Where we used to mostly gather information on complaints and turn it over to the investigating agency, we're pursuing it a little further to get the investigation along," said Candace Steward, volunteer coordinator for the ombudsman's office, a nonprofit organization.
'Expanded our role'
The extra work has meant going so far as to cite the Health and Safety Codes being violated so that investigators can get out to the facilities as quickly as possible.
"It's expanded our role, but we don't have expanded resources," said Sylvia Taylor, the executive director of the ombudsman's office.
Taylor's records indicate that the number of complaints her office has filed against nursing homes has gone up more than 300 percent in the past five years, from 134 in 1999 to 584 last year.
"We used to count little things," said Suzan Neely, support services coordinator for the ombudsman's office. "Now the complaints are major."
The key, said McGinnis, is for families to remain vigilant.
"We tell people all the time, 'You are your brother's and sister's keepers,' " she said. "If food for your mother is cold, then it's probably cold for everybody else. If it's short-staffed on the night shift, then your mother is probably not the only one who isn't getting the care they need. We tell people, the more you visit, the better care your relative is going to receive."
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