FAILING NURSING HOMES HEALTH, SAFETY VIOLATIONS CITED IN 98% IN COUNTY.

Byline: Harrison Sheppard Staff Writer

Nursing homes in Los Angeles County rank among the worst in the state, with 98 percent receiving citations for serious problems, according to a new study by a nursing home workers union.

Researchers in the study, to be formally released later this week as part of the union's effort to win higher wages and better staffing, found that all but 2 percent of Los Angeles County nursing homes received citations in 1999 for conditions that cause potential or actual harm to residents.

The Service Employees International Union, which represents some nursing home workers, studied county inspection reports and compiled information that indicates there are serious problems in the region's nursing homes.

``Nursing homes in Los Angeles County are in a disgraceful state,'' said union spokeswoman Lisa Hubbard.

``Anyone who has a loved one in a nursing home, or may anticipate needing to put a family member in a nursing home, should take a serious look at this report and what it says about nursing homes.''

Representatives of nursing homes and the county inspection agency said the high rate of cited violations, however, reflects tough inspection requirements and is not necessarily a sign of terrible conditions.

But the union study was bolstered by a report released Tuesday by state Attorney General Bill Lockyer, who found many serious problems in Southern California nursing homes.

The union is pushing for legislation introduced in February by Assemblyman Kevin Shelley, D-San Francisco, that would increase minimum staffing by one-third. The union argues that inadequate staffing is one of the main causes of problems.

An official with the county agency that inspects nursing homes for the state said the inspections are stringent.

``I believe we enforce it as strictly as we can,'' said Monica Austin, program manager for the county Department of Health Services in the division that inspects facilities on behalf of the state. ``That's why the public records show we have a lot of violations - because we are enforcing, rather than just turning our eyes away.''

The attorney general's staff performed 28 surprise inspections at nursing homes in Southern California last year. Lockyer said his staff asked county prosecutors to consider possible criminal charges involving seven of the 28, and cases against seven others were referred to the state Department of Health Services for administrative action.

Inspection teams frequently reported finding dangerous objects left within patients' reach, the smell of urine or feces, bug infestations and other dirty, damaged or unsafe conditions.

Elizabeth Lawrence of Sherman Oaks experienced some of the problems firsthand when she brought her 73-year-old mother, left paralyzed by a brain tumor, to a nursing home in 1997. Lawrence said the care was so bad, she pulled her mother out within five days.

But other nursing homes were just as bad, she said. After taking her mother out of four within six months, Lawrence decided to have her mother live with her until death.

``It was basically one horrible thing after the next,'' Lawrence said about the nursing homes.

She said she saw certified nursing assistants who didn't seem properly trained and often neglected their duties. They didn't change her mother's diaper properly. They positioned her improperly on her bed so that the feeding tube was at a wrong angle and went into her lungs.

At one nursing home, Lawrence said, her mother was not properly secured in a wheelchair and fell on her head only a few days after brain surgery.

Lawrence advised anyone who puts a member of the family into a nursing home to spend some time there and to observe for an entire day whether the nursing assistants appear to be doing their jobs properly.

A spokeswoman for the nursing home industry agreed with some of the workers union's points - for example, that workers are underpaid and homes need more staffing. But Betsy Hite of the California Association of Health Facilities said the state and federal governments need to provide more money to improve conditions.

Hite said nursing homes receive about two-thirds of their funding from government Medicare and Medicaid programs. She said 14 percent of the facilities statewide filed for bankruptcy last year.

Hite said the state inspection process covers hundreds of different checkpoints, making some violations likely at every facility.

``It's amazing that any of them are in substantial compliance,'' she said. ``The definitions of some things that can get written up - as potential to cause harm - are absolutely ludicrous.''

For example, she said, if a used tissue is on the floor or a bed railing is left down during an inspection, a facility can be cited.

``You need to be able to tell a good home from a not-so-good home, and the survey system we have right now doesn't let you do that,'' Hite added.

She also criticized the union, saying its leaders are more interested in criticizing nursing homes, in an effort to unionize more facilities, than in working with facility operators to try to secure more government funding.

Among other findings in the report:

--Violations found in Los Angeles County nursing homes included administering unnecessary drugs, inadequate infection control programs, and failure to maintain adequate nutrition.

--In Los Angeles County in 1999, only eight out of 344 facilities met safe staffing levels recommended by the National Citizens Coalition for Nursing Home Reform. The recommended staffing level is 4.13 hours of direct care per resident per day, while the median in Los Angeles County was 2.71 hours.

--The median pay for certified nursing assistants in the nursing homes was $7.13 an hour in 1999, below the poverty line. Hubbard said the state increased funding for nursing homes two years ago by $470 million, but little of that money resulted in salary raises for CNAs.

Industry spokeswoman Hite, however, said the pay for CNAs has increased since then to an average between $8.50 and $9 an hour in Los Angeles and closer to $10 statewide.

Hubbard said nursing homes in Los Angeles County, where about one- third of all in the state are located, rank as probably the worst on average in California.

But she added that conditions in nursing homes are not much better in the six-county San Francisco Bay Area, where 5 percent were in full compliance with the regulations, compared with 2 percent in Los Angeles.

Austin said one of the problems is that her county agency lacks the power to make sure nursing home operators correct problems that county inspectors spot.

Under federal rules, when a nursing home is cited for violating a rule, operators usually need only to produce a correction plan - without proof the plan has been implemented, she said.

The agency has power to impose a remedy or even permanently shut a facility down only in the most serious cases, those threatening physical harm to residents, she said.