NURSING HOMES: FATAL NEGLECT

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The idea of using death certificates to try to prove fraud was born at the Creekside facility. Shortly after Rhoda Johnson moved into Room 52 of the nursing home in 1992, her daughter Ila Swan became concerned about her care. Swan, a 57-year-old former telephone worker, says her anxiety grew when she saw a woman in Room 51, across the hall, try to climb out of bed after her calls for a nurse went unanswered for an hour. According to the woman's roommate, as the woman struggled to get out of the bed, she toppled and struck her head on the tile floor. She lay there for 20 minutes, her cries for help going unanswered by the staff as a pool of blood grew around her. She died a short time later. Swan visited the county records office to review the woman's death certificate and those of others who had died while residing at Creekside and other nearby nursing homes. She was startled to find 10 questionable causes of death listed on the first 30 she reviewed. "They'd listed malnutrition, dehydration, bedsores and urinary-tract infections as causes of death," Swan says. "These nursing homes were killing people."

Soon Rasor and investigator Robert Bauman heard of Swan's work. Intrigued, they began working with Packard to obtain records listing the cause and place of death for every Californian who died from 1986 to 1993. More than 300,000 had died in nursing homes.

What happened next surprised Rasor and Bauman most. Nearly 22,000 of the nursing-home deaths were attributed to lack of food or water, infections or internal obstructions--all preventable, at least in theory. Packard and his investigators didn't add deaths to their list if the deceased suffered from other ailments that exacerbated those four causes. So people who died of both cancer and malnutrition, for example, were not counted.

Many nursing homes have become dangerous places largely because they are understaffed--and underregulated. The Federal Government doesn't dictate staffing levels, and state efforts at regulating quality are meager. With 2 of every 3 dollars spent by nursing homes going to payrolls, the most tempting way to increase profits is to cut personnel.

Generally, the nursing-home industry likes to settle lawsuits quietly and often hands over money only in exchange for silence. But that didn't happen at Creekside, where lawsuits alleging neglect have recently been getting into the public record. Four former residents of Creekside have won more than $2 million in settlements after alleging poor care. An additional four suits are pending. In fact, Packard's California death list contains the names of dozens of people who died there.

Creekside, which opened in 1989, is a handsome place, its fieldstone-walled foyer graced by a big aquarium. Its brochure boasted of private patios and a recreation director who "understands the subtle limitations of age." It promised "all the comforts of home" plus "state-of-the-art nursing equipment" for its 120 residents.