Hope I Die Before I Get Old

Arizona has the power to make nursing homes provide good care. Too bad it doesn't use it

Fewer than half of those citations resulted in fines or other punishment.

Government has a strong hammer, even in Arizona, where social services are notoriously below par. The state can revoke licenses and shut down nursing homes. It can issue fines. It can appoint temporary managers to take over homes when administrators aren't keeping residents safe.

But that doesn't happen very often.

Katherine Bautista says a nursing home without towels doesn't bother her, but says she'd like to get outside more.
Peter Scanlon
Katherine Bautista says a nursing home without towels doesn't bother her, but says she'd like to get outside more.
Peggy Grunden is trying to do what the state didn't do to make Mara Villa Care Center in south Phoenix a safe, livable place.
Peter Scanlon
Peggy Grunden is trying to do what the state didn't do to make Mara Villa Care Center in south Phoenix a safe, livable place.

When nursing homes do pay, it's usually at the barrel of a lawsuit, and years after the fact. Now the Legislature might change that ("A Legal Matter").

At Glendale Care Center, a nursing home on the west side of town, at least five residents died in 2000 and 2001 because of poor care, according to lawsuits filed in Maricopa County Superior Court. The home's owner has settled most of the cases. After the first three deaths in 2000, the federal government issued a $17,000 fine and banned new Medicaid or Medicare patients for three weeks. After two more deaths in 2001, the feds banned new patients for all of two days.

The state issued no fines or other penalties.

In fact, until 2003 the state never fined nursing homes at all. Even now, fines aren't automatic. When they are levied, fines are paltry, and the state rarely invokes the maximum $500 penalty.

State health officials haven't shut down an Arizona nursing home in at least seven years, and officials can't recall any cases where the state has appointed temporary administrators to protect residents.

The regulators admit that they're not where they need to be.

"Frankly, I would like to see more civil penalties and criminal prosecution on a larger scale," Wynn says. "Slowly, we're ramping up. We're really improving in the way we investigate complaints. You'll probably see a more gradual shift toward civil monetary penalties."

But regulators sound more like lobbyists for the nursing home industry than watchdogs as they explain why they haven't gotten tough. Nursing homes, they say, operate on tight financial margins.

"We don't want to . . . ," begins Mary Wiley, assistant director of the state health department's division of licensing services. Wynn finishes the sentence.

"Hasten their demise," Wynn says.

But real people are dying out there.


In theory, the nursing home business is heavily regulated. In practice, enforcement is an exercise in threats and wrist taps. As usual, government officials cry poverty.

State regulators say they're hampered by a shortage of experienced inspectors and a high turnover rate.

DHS is now fully staffed with 27 inspectors who respond to complaints and conduct annual inspections, but there's a big caveat: More than half have been on the job less than nine months, and it takes at least 10 months for a nursing home inspector to become proficient. Besides inspecting each of the state's 134 nursing homes annually, a process that can last as long as five days for each home, these inspectors respond to more than 800 complaints each year.

The number of possible violations exceeds 150, including everything from failure to treat bedsores to failure to deliver mail to residents. At least four agencies have a hand in nursing home oversight, but the buck stops with DHS, which is responsible for finding out what went wrong and issuing citations.

There's no shortage of information on the Internet, but it's divided between federal and state Web sites, with no single place a consumer can go to find out whether a home is good, bad or mediocre. In short, you have to dig to get to the truth.

Unlike online information, verbatim reports include allegations that could be true, but that the state wasn't able to prove. It can take weeks for DHS to produce inspection and complaint reports, which cost 25 cents per page and contain detailed information rather than online summaries that often don't capture the full gravity of a violation. Otherwise, you must settle for a bureaucracy's abbreviated version or trust a nursing home to produce inspection reports upon request.

New Times has found:

• The Arizona Department of Health Services has a history of downplaying the seriousness of violations in reports to the federal government, which can fine homes or ban admissions.

• Penalties are light. The maximum fine is $500, although that can be ballooned in some cases -- say, a bedsore that goes untreated for several weeks -- if the state levies the penalty on a per-day basis. Other states have much bigger sticks. In Washington state, the maximum fine is $3,000; in California, it's $100,000.

• DHS doesn't report cases to the Attorney General's Office for listing on the state elder-abuse registry, as required by state law. The registry is supposed to serve as a quick way for the public to find out who's been giving substandard care.

Since the health department started issuing fines last year, the state, as of August, had fined a dozen Maricopa County nursing homes a total of $30,650. The biggest were levied against Plaza Del Rio in Peoria, which was hit with a $14,100 penalty for not getting a state license after an ownership change, and Freedom Plaza Care Center in Peoria, which paid $8,050, also for not getting a license after the home changed hands.

At least nine Maricopa County nursing homes haven't been punished at all after inspectors found patients had suffered real harm because of poor care. The cases include:

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