Hope I Die Before I Get Old

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Even then, what shows up on the Internet can be a far cry from what actually happened. Take, for instance, a woman at Desert Cove Nursing Center in Chandler who developed gangrene in her right foot in early 2003. There was no mention of required weekly skin checks in the woman's record, nor had the home adequately addressed her risk for developing circulation problems in her foot. A dialysis center outside the home called paramedics when she complained of a headache, and was not as responsive as usual. By then, her toes were black, and doctors doubted whether they could be saved.

The state took no action, so nothing appears on the state's Web site. The federal government fined the home $1,500 and dutifully summarized the violation on its Web site for consumers.

Here's how the violation read: The home failed to "comply with program requirements between annual inspections; although it corrected these problems before the most recent inspection."

Unless you make a public records request, wait days or even weeks for a response and pay for the inspection report, that's all the information you'll get.

It's a problem easily solved: The state health department could post inspection reports on the Internet so the public would have a firsthand picture of what really goes on in nursing homes. At least three states, including Alabama, Iowa and Minnesota, post reports online. Industry insiders say they're all for it, but Arizona health officials plead poverty -- there's no money to post inspection reports on the Web, they say.

Theoretically, the public shouldn't have to rely on the department's Web site to find out what's going on in nursing homes.

Under Arizona law, any state agency that substantiates an allegation of abuse or neglect that has caused an injury must tell the Attorney General's Office and provide a written copy of its decision so that the information can be included in the state's elder-abuse registry. The registry is filled with complaints filed by lawyers who have sued nursing homes, but the state health department doesn't forward copies of inspection reports documenting harm to the Attorney General's Office for inclusion on the registry, which is easily accessible to the public.

The system is so big that it's become unwieldy. With at least four agencies that take complaints, the regulatory process can be confusing, for both nursing homes and consumers, says Linda Schoenbeck, director of utilization services for the Health Services Advisory Group, which has a federal contract to help nursing homes improve. She remembers a meeting a few years ago on nursing homes in the Governor's Office. "I was in this room with all these people, and I'm thinking, 'We're all taking care of the same patients, but we don't even know each other,'" she recalls.

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."

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?"

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Bruce Rushton