Nursing home industry representatives attribute problems, in part, to a nationwide difficulty in attracting and keeping quality, skilled staff.
"In California also, we don't have enough licensed vocational nurses, and we don't have enough working aides or certified nursing assistants," says Anne Burns Johnson, CEO of the California Association of Homes & Services for the Aging. "There are not enough people entering the field. And so staffing becomes more complicated when you can't even hire people."
Insufficient state and matching federal Medicare funding levels are an important reason, she says. "The reimbursements are low compared to what the residents' needs are," she says, and so nursing assistants, paid through those funds, can average around $7 to $9 per hour.
Waxman plans to introduce a bill this week, designed to improve nationwide nursing home care. Among other things, it would increase funding, set minimum staffing limits, increase Internet disclosure of nursing home conditions, and impose new fine levels.
Waxman, who's mother is in a home in Maryland, also believes insufficient funding is a cause of problems: "[U]nless we are willing to pay nursing homes enough to do their job, intolerable incidents of abuse and other types of mistreatment will continue to persist … "
He said he knows many nursing home operators are "dedicated to providing the best care possible," and who "would never knowingly tolerate abuse or other dangerous practices in their facilities."
But added: "[T]he bottom line is clear: Something clearly needs to be done to improve nursing home conditions," said Waxman. "It would have been intolerable if we had found a hundred cases of abuse; it is unconscionable that we have found thousands upon thousands."
Johnson maintains that a higher level of care is provided at not-for-profit facilities, such as those represented by her organization.
"Most of our facilities are small, community-based and religious-based," she says.
Queale of the California Association of Health Facilities, which represents for-profit facilities, says for-profit care can be just as good if not better.
But she adds some not-for-profits have advantages because they have higher staffing with more volunteers, and they get more government funding.
Johnson notes nursing home care is inherently complicated because residents frequently have multiple medical problems, are frail, and in most cases would prefer to be in a different setting. (See: Will They Need Help?)
When putting people in a facility, says Queale, "[relatives] should do research ahead of time if possible, get referrals from their physician or word of mouth about a good reputation."
A Snapshot Look
Another report prepared by the minority staff of the Special Investigations Division, released last Monday, found more than 70 percent of 59 homes in one Pennsylvania congressional district failed to meet federal health and safety standards during recent state inspections.
Such standards included measures for preventing pressure or bed sores, providing sanitary living conditions, and protecting residents from accidents, that report said.
More than half the homes, it said, had violations that caused actual harm to residents or had the potential to cause death or serious injury.