‘Improvement needed’

Local nursing homes weren’t attorney general’s main target, but they fall under the same court order

FRUSTRATED <br>Tat DeSoto, shown with his wife, Nellie, at the SunBridge Care Center for Paradise, said he sympathizes with nursing homes, which are having a tough time getting and keeping enough staff members on board. Still, he said, they should comply with all the laws.

Tat DeSoto, shown with his wife, Nellie, at the SunBridge Care Center for Paradise, said he sympathizes with nursing homes, which are having a tough time getting and keeping enough staff members on board. Still, he said, they should comply with all the laws.

photo by Tom Angel

Where the money goes: at DeSoto, whose wife is in a nursing home, says that understaffing especially stings in light of the hefty compensation drawn by health care executives. For example, the president of Manor Care Inc. takes in $3.7 million a year, while Tenet Healthcare Corp.'s chief gets $3 million.

Tat DeSoto visits his wife, Nellie, at SunBridge Care Center for Paradise at least twice a day, sometimes dropping in at odd hours—even 3 in the morning recently—to make sure his 79-year-old partner of 60 years is OK. “I keep a close watch on her,” he said.

“I have nothing but admiration and respect for the CNAs and the nurses. They’re underpaid and overworked,” DeSoto said. But too few staff members has been “a constant issue,” as dozens of patients need to be kept dry, turned to avoid bedsores and have their hygiene needs taken care of.

DeSoto, who has repeatedly reported alleged code violations to authorities, felt at least a little vindicated last week when California Attorney General Bill Lockyer announced a landmark civil settlement with the corporation that owns the Paradise nursing home—plus Chico Creek Care and Rehabilitation in Chico—requiring it to step up the level of care in its facilities. Sun Healthcare Group will spend $2 million a year to monitor and implement reforms ranging from increased staffing to “ensuring patients are treated with dignity and respect.”

DeSoto said the settlement gives family and friends of residents another outlet: They can call the Attorney General’s Office when things aren’t right.

No events at the Chico and Paradise homes sparked the enforcement action; it was the death of two residents at SunBridge Care and Rehabilitation of Burlingame during a June 2000 heat wave. The facility, which has since been sold and will be upgraded, had no air conditioning, and six residents who survived severe dehydration, heat exhaustion or heat stroke had an average body temperature of more than 106 degrees, the attorney general reported. Sun Healthcare’s subsidiary, Rose Rehabilitation Center, pleaded “no contest” to a felony violation of elder abuse.

Dan Hill, SunBridge’s Albuquerque-based spokesman, said, “All along, we’ve said serious mistakes were made in Burlingame. Clearly there was wrongdoing, but [SunBridge] didn’t intend to harm people. … It was a crisis that wasn’t handled properly.”

Lockyer went after SunBridge civilly and criminally in an attempt to improve the quality of care. “This settlement marks the first time in California that a national nursing home chain has been prosecuted by the Department of Justice for poor-quality care,” he stated in a press release.

The settlement—approved by a San Mateo County judge Oct. 3—covers all of SunBridge’s 80 nursing homes, serving some 8,000 mostly elderly patients in California.

Hill said the injunction basically means “we will follow the laws that are already on the books” and “the attorney general is now scrutinizing the care that we’re giving the patients in all our buildings.”

Pat McGinnis, executive director of the San Francisco-based California Advocates for Nursing Home Reform, said the settlement is a “big deal,” if only because, “instead of just forcing them to pay money … they’re actually forcing them to make changes in care.”

She said it would take a lot to change much at chains like SunBridge, which is the largest in California, because there’s such a profit motive in the industry.

Publicly held SunBridge has been reorganizing under Chapter 11 bankruptcy rules, and McGinnis said that’s because the chain overextended itself by buying up more nursing homes overseas rather than improving its 250 facilities in the United States.

But the problem, McGinnis said, is endemic to nursing homes, and Americans are in denial about the type of care their elderly are receiving.

Joe Earley, a Paradise attorney who has represented clients who reported violations and allegedly were punished for it, said, “I’m glad [the attorney general] did something, but it’s still not enough.”

He said it would take relatives of residents, and whistle blowing employees at local levels, to make a real difference in nursing care in the United States.

During the past four years, SunBridge had been cited more than 100 times and fined nearly $1 million.

Hill, of SunBridge, said most of the citations were related to staffing violations, and, “100 over four years in 100 buildings isn’t as much as it sounds like.” Still, “the truth of the matter is we don’t want to have any citations.” He said it’s hard to hire and retain staff, but SunBridge is trying its best.

In January 2001, the SunBridge Care Center for Paradise received a Class B violation—fairly rare—for not maintaining the legally required staffing levels. The company was fined $950.