California’s broken nursing home system broke my heart

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Prayers and thoughts, prayers and thoughts. I could paper the walls with them. But while enduring an eight-week, full-frontal immersion course in California’s broken nursing home system, our family needed hands-on help.

In the middle of the night, I would awaken in tears.

My friend Myra led me to Paula Wolfson, elder care consultant at the Palo Alto senior center Avenidas, and to Jewish Family and Children’s Services. Gabe Kralik, a state-certified nursing home ombudsman, provided other resources.

Our crisis began April 12, when my 69-year-old brother, who lives with us, told us to call 911. Whisked to Stanford Hospital, he underwent emergency surgery for an intestinal blockage. Twelve days later, the hospital discharged him to an old facility for rehab and nursing patients that was not of our choosing. (I objected but was told we had no choice because that’s where a bed was available.) For a couple of weeks, he was housed three to a room, sharing a small toilet room with another three-patient room.

Unfortunately, my brother was admitted on a Saturday, when staffing is minimal and rehab virtually nonexistent. He was left unattended for several hours in the wrong kind of bed for a patient with a pressure wound.

Pressure wounds (bedsores) are primarily the result of hospital and nursing home negligence. Left to fester, an infected wound could become septic, ultimately causing organ failure and even death. Because of inattention at that time and on subsequent weekends — when doctors are rarely around to see that their orders are carried out — my brother developed a painful stage-four infection that kept him virtually bed-bound for the better part of two months. In addition, he developed vertigo, which complicated his recovery.

As my brother’s next of kin and primary caregiver, I tried to keep on top of things because he couldn’t. When the facility wanted to discharge him six weeks later, my brother was in worse shape than when he was admitted. Fortunately, the facility’s physician rescinded that order.

When my brother finally was discharged on June 18, we were ready to put subacute care behind us. We told the staff that had my brother received proper treatment at the beginning of his stay, chances are he would have returned home after two or three weeks. The head nurse took our complaints to heart.

Our nursing home system is in disrepair, with a shortage of beds and staffing, and concerns about how state and federal funding is allocated.

An ailing patient, we said, requires just as much care on a Sunday as on a Monday. But the doctor’s orders to turn my brother every two hours were not followed. Once, when my brother’s call button went unanswered, I ran through the hallways to recruit a couple of attendants. On another weekend, we asked a nursing assistant to help my brother out of bed and were told nobody was available to lift him until Monday, when physical therapists were on hand. When my husband complained at the nursing station, a couple of attendants came to my brother’s aid, but unfortunately, they could not lift him without causing pain. Perhaps that explains why, at one point, he went 11 days without a shower.

As I spoke with social workers, advocates and former patients, I discovered that our nursing home system seems to be in disrepair, with a shortage of beds and staffing, and concerns about how state and federal funding is allocated. The California legislature and AARP are currently championing measures (AB 650 and SB 650) to hold nursing homes accountable.

Problems were rampant even before Covid, according to a statement from AARP California director Nancy McPherson: “The generally low quality of care and poor oversight of these nursing homes was well known, as evidence[d] by a May 2018 report from the California State Auditor entitled ‘Absent Effective State Oversight, Substandard Quality of Care has Continued.’

“The report revealed that between 2006 and 2015, the number of substandard care deficiencies cited in nursing facilities increased by 31 percent. Despite this increase in deficiencies, the net income for three of the largest nursing home companies in California increased significantly during the same period. In 2006, none of those companies’ net income exceeded $10 million; in 2015, their net incomes ranged between $35 million and $54 million.”

When I kvetched to synagogue friends, some who had been placed in posher facilities also complained about inadequate care.

“On Mother’s Day, they put flowers on the table, but I couldn’t get a nursing assistant to answer my call button on a Saturday night,” said a friend who recently was at a facility on the Peninsula.

“I could ring the bell 100 times, and nobody would answer,” said Carole, who had been at a modern South Bay facility. “If somebody doesn’t have an advocate, they’re really screwed.”

Once I reached out, I found advocates and common experiences. It’s not just California. A friend in New York voiced similar frustrations. The population is aging, nursing homes are understaffed, patients are sicker and beds are at a premium. The problem will not go away on its own.

Janet Silver Ghent
Janet Silver Ghent

Janet Silver Ghent, a retired senior editor at J., is the author of “Love Atop a Keyboard: A Memoir of Late-life Love” (Mascot Press). She lives in Palo Alto and can be reached at [email protected].