Hope I Die Before I Get Old

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The Arizona Department of Health Services is charged with protecting residents at assisted-living facilities and nursing homes. But a New Times analysis shows regulators are soft on the facilities that are supposed to keep the state's elderly safe, particularly nursing homes, which house the most vulnerable.

Since 2001, DHS has issued at least 65 citations to 30 of the 77 nursing homes in Maricopa County for neglect, abuse and mistakes so serious that residents either suffered injuries or death.

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.

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.

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Bruce Rushton