NURSING HOME INDUSTRY AN IFFY BUSINESS : RECORDS DON'T TELL WHOLE STORY.Byline: Yvette Cabrera Daily News Staff Writer There is a little old woman with Alzheimer's disease Alzheimer's disease (ăls`hī'mərz, ôls–), degenerative disease of nerve cells in the cerebral cortex that leads to atrophy of the brain and senile dementia. who strolls the halls of the Ararat Nursing Facility in Mission Hills, getting some exercise under a nurse's watchful watch·ful adj. 1. Closely observant or alert; vigilant: kept a watchful eye on the clock. See Synonyms at aware, careful. 2. Archaic Not sleeping; awake. eye. She shuffles across polished floors, past perfectly stacked trays of banana snacks, past the Employee of the Month plaques and activity calendars hanging on the pastel-pink walls, and through the freshly aired rooms. With zero citations from the state Department of Health Services Department of Health Services may refer to:
Valley, southern California, U.S. Northwest of central Los Angeles, the valley is bounded by the San Gabriel, Santa Susana, and Santa Monica mountains and the Simi Hills. area that have the best possible patient-care records. You literally can smell the difference between Ararat's facility and the Grand Valley Health Care Center in Van Nuys, where the lobby is elegantly decorated dec·o·rate tr.v. dec·o·rat·ed, dec·o·rat·ing, dec·o·rates 1. To furnish, provide, or adorn with something ornamental; embellish. 2. but the odor of urine wafts its way into visitors' nostrils. Grand Valley received nine citations in five years, giving it the fifth-worst record in the Valley, just slightly better than the Reseda Convalescent con·va·les·cent adj. Relating to convalescence. n. A person who is recovering from an illness, an injury, or a surgical operation. convalescent 1. pertaining to or characterized by convalescence. 2. Hospital, which was at rock bottom of the list with 11 citations. In the wake of Reseda Convalescent's sudden closure late last month, residents with loved ones loved ones npl → seres mpl queridos loved ones npl → proches mpl et amis chers loved ones love npl in nursing homes were left grappling with questions about the industry and how it is regulated. While the state Department of Health Services provides people with guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. and public records of facilities, interpreting those records can often be confusing. Even more frightening, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. watchdog groups, is that records don't show the whole picture and enforcement of state regulations is lax. Consider: Although the Department of Health Services issues citations and levies fines - a maximum of $25,000 for patient deaths caused by neglect - if a home does not commit the same mistake within 12 months, the fine is waived automatically. Complaints by residents to regulators can often lead to citations, but family members and residents tend not to file complaints for fear of retaliation RETALIATION. The act by which a nation or individual treats another in the same manner that the latter has treated them. For example, if a nation should lay a very heavy tariff on American goods, the United States would be justified in return in laying heavy duties on the manufactures and from nursing home staffers, according to California Advocates for Nursing Home Reform. The San Francisco-based group monitors regulators and advises the public about nursing homes' quality. The state Department of Health Services licensing and certification program surveys every home once a year. But since nursing homes can predict when inspectors will arrive, they shape up in time for reviews, the group contends. A nursing home's records accumulate from the date it opens and stay with the home, even when management changes. This leaves an unclear picture of which management company amassed citations, complaints or deficiencies. ``Obviously the regulation system is not working,'' said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform. ``One of the things we have been pushing for is a state database on ownership of nursing homes. Who are these people, what else do you own, what's your track record?'' she said. ``We have no national database either, and I've seen it time and again where out-of-state owners come in and perform terribly because they're not fiscally responsible.'' One-third of the 1,460 nursing homes in California are in Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. County. They are regulated by the county Department of Health Services, which is contracted by the state to enforce regulations and inspect the facilities annually, said Ken August, spokesman for the department. The annual surveys can be supplemented by unannounced visits, which also can occur when the department receives a complaint, August said. But the public should not just rely on annual surveys, because the results may be skewed skewed curve of a usually unimodal distribution with one tail drawn out more than the other and the median will lie above or below the mean. skewed Epidemiology adjective Referring to an asymmetrical distribution of a population or of data by nursing homes that prepare in advance for reviews. ``The problem is the facilities can figure out when the survey happens,'' said Prescott Cole, an attorney who runs the nursing home advocacy group's legal referral service. ``In one instance, a nursing home knew the survey was coming and the administration hired more nursing staff,'' he said. Typically, ``after the state licensing people go in, the nursing home will fire the staff they just hired,'' Cole said. State inspectors have a three-tiered group of options to force a facility to comply with state regulations: complaints, which are lodged by patients or families; deficiencies, which are typically for administrative errors; and citations, which signal potential patient neglect or abuse. If these methods don't bring about improvement, the state can withhold with·hold v. with·held , with·hold·ing, with·holds v.tr. 1. To keep in check; restrain. 2. To refrain from giving, granting, or permitting. See Synonyms at keep. 3. Medicare and Medicaid Medicare and Medicaid U.S. government programs in effect since 1966. Medicare covers most people 65 or older and those with long-term disabilities. Part A, a hospital insurance plan, also pays for home health visits and hospice care. funding, or force a home to close. That rarely occurs. But inspection surveys and records may not show the complete picture at a home, since patients and family members are often afraid to report violations. ``I hear this over and over again, where people say when they complain to an administrator it gets worse,'' Cole said. Deficiencies are noted if a home doesn't comply with a state requirement. Typically, deficiencies are items that have minimal effect on the safety and health of patients, said Carla Framiglio, assistant deputy director of the state Department of Health Services. After noting a deficiency, inspectors give the nursing home a deadline to correct it and then return to check if the facility has complied. Inspectors issue three classes of citations for the worst flaws that threaten patient safety. Class B citations are for falsification falsification /fal·si·fi·ca·tion/ (fawl?si-fi-ka´shun) lying. retrospective falsification unconscious distortion of past experiences to conform to present emotional needs. of records or ignoring dietary needs, and carry fines from $100 to $1,000. Class A citations are issued if a building is in disrepair or if nurses overmedicate o·ver·med·i·cate v. To medicate a patient excessively. or mismedicate patients. Fines range from 1,000 to $10,000. And if a resident dies from nursing home abuse or neglect, a Class AA citation is issued and fines from $10,000 to $25,000 are levied. Despite the stiff fine schedule, most nursing homes get off scot-free since they don't commit the same violation twice in one year, according to California Advocates for Nursing Home Reform. Framiglio concedes that nursing homes could and should be held more accountable. ``The regulation is effective, but it could be more effective if we could collect the penalty when we issue a citation,'' she said. What's more, in the 15 days a nursing home is given by law to contest a citation, it can cut a proposed fine in half if executives choose not to contest it, Framiglio said. The state also has tougher weapons, she said. It can curtail cur·tail tr.v. cur·tailed, cur·tail·ing, cur·tails To cut short or reduce. See Synonyms at shorten. [Middle English curtailen, to restrict federal funding or remove a nursing home's ability to bill Medi-Cal or Medicare. Even an eye-opening record can be misleading, since new management companies can take over a facility at any given time. At the Grand Valley Health Care Center, for example, N&M Management took over two years ago and has not had a citation in that time, public records show. Nevertheless, the company's Van Nuys home bears the fifth-worst record in the Valley since 1992. And that frustrates Grand Valley Administrator Janice Handwerk. ``If someone does take over a facility, unfortunately this trail of citations follows them,'' said Handwerk, who recommends that families visit nursing homes and talk to residents and employees to get a real picture of each facility. At the Santa Clarita Santa Clarita, city (1990 pop. 110,642), Los Angeles co., S Calif., suburb 30 mi (48 km) NW of downtown Los Angeles, on the Santa Clara River; inc. 1987. Situated in the Santa Clara valley and nearby canyons, Santa Clarita includes the former towns of Canyon Country, Convalescent Hospital, which was ranked in the bottom seven facilities for the worst citation records, Administrator Miriam Cristofalo said citations were often reported by the facility administrators. ``Most of the time we report things to the Department of Health because we are mandated by law,'' said Cristofalo, who recommends that the public inspect the most current surveys of a facility to get the most up-to-date information. ``We just had a survey in June of 1997,'' she said. ``We did very well; there were no citations.'' Executives of the other Valley facilities with the worst citation records could not be reached or did not respond to requests for interviews. At the Ararat Nursing Facility, the home with the best possible record since 1992, good care seems tied to a philosophy of always trying to improve. Ararat is an Armenian center that accepts patients of all backgrounds. Every resident and family member is treated with compassion and respect, and every day is seen as an opportunity to improve service, said Margo Babikian, director of nursing. ``Performance improvement, quality improvement is an everyday activity,'' she said. ``There is no end to the process; there are only milestones. ``We know we will never reach that milestone, but we will continue to strive for it.'' RATING NURSING HOME CARE Twenty-four of the San Fernando San Fernando, city, Argentina San Fernando (săn fərnăn`dō), city (1991 pop. 144,761), Buenos Aires prov., E Argentina. It is a district administrative center in the Greater Buenos Aires area. Valley's 96 nursing homes earned the best possible record by receiving no citations from 1992 through 1996 from the Los Angeles County Health Department. Seven others - including the Reseda Convalescent Hospital, which closed suddenly and evicted its residents late at night Sept. 26 - had the worst records. County inspectors, under contract with the state Department of Health Services, visit Valley nursing homes at least once, possibly twice, a year and note problems in three categories: complaints, which are lodged by residents; deficiencies, which are minor infractions; and citations, which range from falsification of medical records to the death of a patient caused by neglect or abuse. BEST RECORD Home Citations 1992-96 Ararat Nursing Facility, Mission Hills 0 Beverly Manor Convalescent Hospital, Panorama City 0 Beverly Manor Convalescent Hospital, Burbank 0 Encino Hospital Skilled Nursing Facility skilled nursing facility n. Abbr. SNF An establishment that houses chronically ill, usually elderly patients, and provides long-term nursing care, rehabilitation, and other services. , Encino 0 Forester Haven, San Fernando 0 Glendale Adventist Medical Center Glendale Adventist Medical Center is located in the Los Angeles suburb of Glendale, California. It was founded in 1905. Glendale Adventist Medical Center is a sister institution of Loma Linda University Medical Center and is a part of the Seventh-day Adventist hospital system. , Glendale 0 Grancell Village of the Jewish Homes, Reseda 0 Imperial Convalescent Hospital, Studio City 0 Magnolia Magnolia, city, United States Magnolia (măgnō`lyə), city (1990 pop. 11,151), seat of Columbia co., SW Ark.; inc. 1855. Its oil industry has been important since 1938. Gardens Convalescent Hospital, Granada Hills 0 Motion Picture & Television Hospital, Woodland Hills 0 Northridge Hospital Medical, Northridge 0 Rockhaven Sanitarium sanitarium /san·i·tar·i·um/ (-tar´e-um) an institution for the promotion of health. san·i·tar·i·um n. See sanatorium. , Verdugo City 0 St. Elizabeth Toluca Lake, North Hollywood 0 Verdugo Hills Hospital D/P D/P Abbreviation for Documents Against Payment. SNF SNF abbr. skilled nursing facility SNF solids-not-fat; a comment on the composition of milk. , Glendale 0 West Hills Regional Medical Center, Canoga Park 0 Windsor Manor, Glendale 0 Sherman Oaks Hospital Sherman Oaks Hopital (SOH) is an 153 bed acute care facility in Sherman Oaks, California, USA and is home of world renowned the Grossman Burn Center. SOH is owned and operated by Prime Healthcare Services, Inc. & Health Center, Sherman Oaks 0 Antelope Valley Hospital Medical Center Antelope Valley Hospital Medical Center or simply Antelope Valley Hospital (AVH) is a public hospital located in Lancaster, California. External links
Chandler Convalescent Hospital, North Hollywood 0 North Hollywood Medical Center The North Hollywood Medical Center, (), was a hospital in the city of North Hollywood, CA. The now decommissioned hospital, which is at 12699 Riverside Drive in the North Hollywood neighborhood of Los Angeles, California, is the location , North Hollywood 0 Casa Verdugo Convalescent Lodge, Glendale 0 Elms Convalescent Hospital, Glendale 0 Laurelwood Convalescent Center, North Hollywood 0 Montrose Nursing Center, Montrose 0 WORST RECORD Home Citations 1992-1996 Glenoaks Convalescent Hospital, Glendale 11 Reseda Convalescent Hospital, Reseda (x) 11 Diana Lynn Diana Lynn (October 7, 1926 – December 18, 1971) was an American actress. Born Dolores Marie Loehr in Los Angeles, California, Lynn was considered a child prodigy because of her exceptional abilities as a pianist at an early age, and by the age of 12 was playing Lodge Convalescent, Sunland 10 Chatsworth Park Convalescent Hospital, Chatsworth 10 Grand Valley Health Care Center, Van Nuys 9 Santa Clarita Convalescent Hospital, Newhall 8 Riverside Convalescent Center, North Hollywood 8 (x) Closed Sept. 26. NURSING HOME EVALUATION CHECKLIST This checklist was developed by nursing home reform advocates to give families a way to gauge the quality of care. The ultimate tip: Ask to see the entire facility, not just the nicely decorated lobby or room. Residents' appearance: Are residents up and dressed for breakfast? Are they well-groomed? Do they appear alert, content and occupied? Are they comfortably positioned or tied in their chairs or beds? Staff: What is the staff-to-resident ratio? Are call bells and resident requests responded to in a timely manner (5 minutes or so)? Are employees courteous cour·te·ous adj. Characterized by gracious consideration toward others. See Synonyms at polite. [Middle English corteis, courtly, from Old French, from cort, court; see ? Do they treat residents with dignity and respect, or is their attitude condescending? Do managers appear to know residents? Is privacy respected? Is there a licensed social worker on staff? Full time? Facility environment: Is it clean, well-lit and free of hazards? Are floors clean and nonslippery? Residents' rooms: How many residents share a room? Generally, rooms should have no more than four beds, at least 3 feet apart, with privacy curtains around each bed. Are call buttons accessible? Are residents encouraged to bring their own belongings belongings Noun, pl the things that a person owns or has with him or her Noun 1. belongings - something owned; any tangible or intangible possession that is owned by someone; "that hat is my property"; "he is a man of ? Hallways, stairs and lounges: Are halls free of obstacles and trash? Are stairways and exits clearly marked? Are there handrails in all corridors? Bath and shower rooms Noun 1. shower room - a room with several showers room - an area within a building enclosed by walls and floor and ceiling; "the rooms were very small but they had a nice view" shower bath, shower stall - booth for washing yourself, usually in a bathroom : How many residents share a bathroom? Do bathrooms have hand grips or rails near all toilet and bathing areas? Is there a call button near the toilet? Menus and food: A menu for the current and following week should be posted. If a menu is not posted, ask to see one. Is the food listed on the menu actually being served? Does the food appear and smell appetizing? Is it nutritious nutritious /nu·tri·tious/ (noo-trish´us) affording nourishment. nu·tri·tious adj. Providing nourishment; nourishing. nutritious affording nourishment. ? Are fresh foods used, or is it mostly canned and frozen? Do residents enjoy the food? Activities: Are activity calendars posted? Do activities cover broad interests? Are they tailored to individual preferences? Miscellaneous: How often do residents' physicians visit? It should be at least once every 30 days. What hospital is used in emergencies? Who should be contacted when there is a problem? For more tips on how to evaluate facilities, call the California Advocates for Nursing Home Reform at (800) 474-1116 or access it on the World Wide Web at www.canhr.org. CAPTION(S): 3 Photos, 2 Charts PHOTO (1--color) Ararat Nursing Facility assistant Ana Hid Mousessian helps resident Vehanoush Baltayan with her ``Happy Feet'' range-of-motion exercises. (2--3--color) A calendar at the Ararat Nursing Facility shows a full-slate of activities planned for the Mission Hills site. At left, Margo Babikian, director of nursing for the highly rated San Fernando Valley home, explains a communications board used for people suffering from Alzheimer's disease. David Sprague/Daily News CHART: (1--color) RATING NURSING HOME CARE (see text) SOURCE: California Advocates for Nursing Care Reform review of state records. (2) NURSING HOME EVALUATION CHECKLIST (see text) Source: California Advocates for Nursing Home Reform Daily News |
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