Nursing homes: business as usual: two decades after the passage of a federal law to clean up the nation's nursing homes, bad care persists and good homes are still hard to find.(CR: INVESTIGATES)

Publication: Consumer Reports

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COPYRIGHT 2006 Consumers Union of the United States, Inc.

In 1987, Congress passed a landmark law meant to improve nursing home care for the elderly. But our investigation reveals that poor care is still all too common, especially at nursing homes run by for-profit chains, now the dominant force in the industry.

CONSUMER REPORTS' analysis found that not-for-profit homes generally provide better care than for-profit homes, and that independently run nursing homes appear to provide better care than those that are owned by chains. In a separate study, we found that many states are lax in penalizing bad homes.

For this report, we analyzed the three most recent state inspection reports for some 16,000 nursing homes across the U.S. We also examined staffing levels and so-called quality indicators, such as how many residents develop pressure sores when they have no risk factors for them.

The Consumer Reports Nursing Home Quality Monitor, formerly the Nursing Home Watch List, is available free at www.ConsumerReports.org/nursinghomes. It lists facilities in each state that rank in the best or worst 10 percent on at least two of our three dimensions of quality. By examining the kinds of homes that tend to cluster at either end of the continuum, we can make some judgments about how likely a facility is to provide proper care.

This year's list, financed by a grant from the Commonwealth Fund, a philanthropic organization, is the fifth we've published since 2000. We've seen little evidence that the quality of care has improved since then. Indeed, 186 of the homes cited for poor care on this list have also appeared on earlier lists of poor-quality homes.

Consider the White Blossom Care Center, part of a for-profit chain in San Jose, Calif. From the outside, it looks like many of the nursing homes that dot the California landscape: wings of residents' rooms and a parking lot full of cars. Inside we saw nothing that would arouse unease. Residents nodded off in wheelchairs, and aides chatted at nurses' stations as an occasional visitor walked through the halls.

White Blossom, though, is no ordinary nursing home. It's one of 12 that have been on each of our lists of poorly performing homes since 2000. Its state inspection, conducted last August and current when our reporter visited in December, raised troubling questions about the care it delivers.

Page after page of the unusually long document detailed failures to follow doctors' orders, perform a pain assessment, monitor pressure sores, screen for tuberculosis, or properly sanitize dishes and utensils. The 43-page report told of a stroke victim with swallowing problems who was left unsupervised with mushy material in her mouth. And it mentioned a medication error that could have been fatal. The survey also reported on the facility's plans to correct the deficiencies that were cited.

The survey, which by federal law must be "readily accessible" in every nursing home, was not visible in the lobby when our reporter arrived. Only after she insisted on seeing it did the home's administrator produce it. A staff member at the front desk said the report wasn't initially available because it was being used by someone else at the time. Steven Earle, White Blossom's administrator, wouldn't comment on specific deficiencies but said that they had been...

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