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

Schoenbeck's organization is supposed to teach nursing homes how to provide good care. The federal government calls it a non-punitive way to improve care. But it's a voluntary program. Just 20 of the state's 134 nursing homes are taking part.

William J. Scanlon, former head of the GAO division that deals with nursing home issues, criticizes the notion that training can take the place of sanctions.

"Most of us know from raising children about the basics required to sustain a human being, basics that some nursing home residents do not receive," Scanlon told the U.S. Senate Committee on Finance last year. "The types of deficiencies we have been talking about involve practices so egregious, so lacking, that one does not have to be a health professional to instantly understand their inadequacy."

Some nursing home residents aren't able to say what's happened to them. But the state knows.
Tifenn Python
Some nursing home residents aren't able to say what's happened to them. But the state knows.
Lucille Ayers with her son James about a year before her death.
courtesy of the Ayers family
Lucille Ayers with her son James about a year before her death.

The nursing home industry argues that government reimbursements are so low that nursing homes can't afford to pay big fines. If the government got tough, the elderly would suffer because homes would go out of business and there'd be a shortage of nursing homes, say the apologists.

Scanlon doesn't believe the hype.

"We've been hearing that same sort of line for the last 30 years," Scanlon tells New Times. "We still have an industry that's about the same size, relative to the size of the elderly population, as it's been for the last 30 years." Beyond that, Scanlon, who left the GAO and became a private health care policy consultant earlier this year, notes that most nursing homes provide good care. "Why do 80 percent of facilities manage to comply?" he asks. "If 80 percent can do it under the same system -- the same Medicaid rates and the same rules -- why can't the other 15 to 20 percent?"


Fines don't always force improvement. And when that happens, the state is reluctant to take further action. Esperanza Manor in south Phoenix is a case in point.

The nursing home on South Seventh Street near South Mountain Park is a home for the poor. Every resident is there courtesy of Medicaid. The home has had a series of owners over the years, but problems have remained a constant.

In 1999, while the home was operating as Thunderbird Healthcare Center, residents were repeatedly assaulting each other so savagely that two men ended up in the emergency room. The home also came under scrutiny after a woman suffered fatal burns that same year. The state failed to substantiate an allegation that she'd been left too long in the sun; the home maintained that the burns resulted from a reaction to a prescription drug. But the incident triggered outrage. Lawmakers organized a task force to study how well the state enforces nursing home standards and keeps the public informed about conditions in nursing homes.

In the end, nothing changed.

Four years later, the home, now called Esperanza Manor, was a quiet hellhole. There was no outrage and no publicity. But people suffered badly.

"When staff pulled the resident's right fingers partially open, the resident loudly screamed out. A foul, pervasive odor emanated from the resident's hand. All fingernails were observed to be yellow and brown and 1/4 to 1/2 inch long. Brown debris was noted under the fingernails and from the hand when the hand was washed. Indentations, that did not lessen when the skin was rubbed, were present on the palm where the fingernails had been and imprints of the resident's fingernails were observed on the palm, which did not lessen when rubbed. The skin of the resident's palm was observed to be white-colored and macerated."

That's a firsthand account from a state inspector who found five Esperanza Manor residents with hands clenched into near fists because they weren't provided splints or hand exercises. Indeed, they didn't even have towels. Residents used sheets and pillow cases to dry off after showers.

No one died at Esperanza Manor last year, but judging from state reports, that was a matter of luck. The home didn't promptly transfer a hypoglycemic resident to a hospital, as his doctor ordered. More than four hours after the transfer order, a relative found the man in a seizure with a pulse of 140, twice the normal rate. Fire department paramedics rushed him to the emergency room. Records showed that the home hadn't checked his medical condition for five hours. The home didn't provide psychiatric care or psychological screenings for suicidal residents, including one man who tried to kill himself with a drug overdose.

One resident had halitosis so bad that the hallway outside his room reeked. Inspectors found no toothbrush or toothpaste in his living quarters and concluded he'd received no dental care. The home's staff didn't change bandages on another resident with oozing sores on his feet, nor did the staff tell the resident's doctor when he developed an allergy to his prescribed antibiotic.

"The resident was observed several times to have loose, soiled, wet gauze wrapped around both of his feet with either no additional foot wear or soiled, wet slipper socks," an inspector wrote.

Residents who were allowed to smoke unattended had burn holes in their clothing. An incontinent resident wandered the home for hours in soiled pants. A staff member who sat beside a man did nothing even though he "had a milky, white nasal drainage that was going into his mouth as he fed himself. The staff member did not make any effort to wipe the drainage and the resident continued to feed himself through the meal." Instead of providing separate bowls, the staff mixed a blind resident's food together. The staff gave corn flakes to another resident who was supposed to eat puréed food only. No one intervened when she poured water over the cereal and shoveled still-dry flakes into her mouth.

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