Is Neglect Ever Benign?

A Look into Los Angeles County Nursing Homes

Joe Wiederhold suffered from a life-changing stroke in early 2016. The local Torrance, California tax accountant, who liked to jog, lift weights and ride motorcycles, was left paralyzed on his right side.

Inside Wiederhold's room

Because her job and problems with both their weights, his life partner, Lynn Cardarelli couldn’t care for him in their home.

Three years ago, Wiederhold, 66, moved to the Bay Crest Care Center in Torrance, where he has experienced some of the indignities and neglect associated with many nursing homes.

Cardarelli said she has found him in soiled diapers and he has been left in bed for long periods of time without physical therapy. He has had clothes stolen, and the food is unappetizing - even inedible, she said.

She didn’t file any official complaints, preferring instead to speak to the home’s administrators. “I don’t blame the people there; I blame a government that has written to affect laws that allow administration who are looking at bottom-line profits.“

Wiederhold is in the nursing care system at arguably one of the worst periods for health care quality in the county.

Molly Davies, Vice-President of the Ombudsman Services of L.A. County, said she has never seen as many significant cases of neglect and abuse like the ones being reported now. From her observations, the most common complaints are gross neglect, inappropriate transfers and failure to respond to assistance request.

The closet Wiederhold shares with his roommate

“We’re in an environment where the enforcement body, which is the Department of Public Health seems to cower to the industry. So they kind of allow facilities to run amok,“ Davies said.

According to the most recent study released by California State Auditor in May 2018 shows that federal health deficiencies between 2006 and 2015 increased by 35%. With Los Angeles County being home to 32% of the state’s total nursing facilities, the problem is more ubiquitous.

“I don’t know the actual year this changed, but I have noticed it has never been as busy or as complex as it is in probably the last five years,“ Davies said of the recent influx of complaints her office has been receiving. “It’s been five to seven years where it’s been really… you know. The complexity is glaring.“

Cardarelli and Wiederhold share their thoughts about the past three years.

Many families choose not to file reports, instead hoping to speak with the staff about their issues, like Cardarelli, which is potentially causing under-reporting of complaints at the state and federal level.

In order for nursing homes like Bay Crest to receive money from programs like Medicare and MediCal, they must submit to federally mandated audits by the U.S. government. If any deficiencies are found, such as mishandling of food, they are cited in a health report. The facility is then required to write up a Plan of Correction where they are supposed to correct any issues found. However, this may not always be the case.

Steve Garcia, a lawyer who specializes in elder abuse care, said that his plaintiff load tripled due to the decreasing quality of care and lack of oversight.

“It’s just lip service,“ Garcia said. “They just file a plan of correction and promise to do all of these new things, and the State of California doesn’t do crap about investigating and ensuring that they do.“

Since the state of California has its own auditing system, homes that rack up numerous deficiencies often go unpunished. According to the State Auditor’s study, only 15% of homes that receive the worst citations were also cited by the state. The lack of citations leads to a lack of penalties, further incentivizing poor quality care, the study said.

The complexity of government oversight makes it hard for consumers to understand their choices in selecting a nursing home. Even with the government’s star rankings, people can still be left with little option. In the State Auditor’s study, over 22% of all facilities scored a one- or two-star rating. In Los Angeles alone, there are 382 homes. A review of the data shows that roughly 140 of those homes, or 36% scored only two stars or less.

Difficult to understand information confusion leads to people wondering if they picked the right place. When their family and friends go into nursing homes, many worry about them when they are there.

Joe Fay’s lifelong friend Michael Rakic, 68, ended up in Alexandria Care Center in early 2018 due to a variety of health problems.

“How would I know what criteria I should be using to evaluate how this facility measures up against those criteria unless some government entity is paying attention?“ Fay said. “If we didn’t have the food and drug administration how would we know whether or not anything is safe?“

After Rakick shuffled between Alexandria Care and Gardner Street Board & Care III, he transferred back to Alexandria with bed sores. Despite his sores healing well, Rakic developed an infection that developed into toxic shock. Rakic died July 4, 2018.

“That kind of sticks in my craw because it just feels that if they just prevented or just treated the UTI in sufficient time, he wouldn’t have died,“ Fay said.

Fay felt that until Rakic’s death, his friend received good care. “I thought the physical therapy efforts that were made at Alexandria were very good. They were very diligent.“ When Rakic had issues with roommates, Fay said that Alexandria Care was responsive to his requests to move, and felt that the facility was reasonably clean.

Despite repeated attempts, Alexandria Care declined to comment. And last year, the facility earned three of the most severe citations in one visit. Their total citation count in that audit was 38, well above the state average of 9.6.

In one instance, the facility failed to perform background checks on some of the staff members, potentially exposing residents to somebody with a history of abuse. There were reports of alleged abuse towards four residents.

Another citation concluded that food was mishandled and that roaches were seen in kitchen storage areas.

Alexandria Care Center and, Bay Crest, the home Wiederhold is a resident of are both under the umbrella of Genesis Healthcare. The company owns 500 nursing homes, 14 of which are in Los Angeles County.

These facilities are two of the roughly 50 out of 382 homes in L.A. County that has at least one type of severe deficiency in the last three years.

California as a state ranks higher than the national average in regarding nursing hours per patient. Nonetheless, families feel ignored.

Both of Rulla Hernandez’s parents, Awad Dayan, 83, and Lamia Dayyan, 71, both entered into Alexandria Care Center within weeks of each other in early 2015. They both had failing health due in part of an advanced age.

“The ratio of caregivers vs. patients is way, way off,“ Hernandez said. “You take about maybe ten rooms, and they may have two people assigned to all of those rooms.“

She had a negative experience with the facility ranging from bad food, falls and stolen clothes. She too chose not to report the claims formally. Despite these issues, Hernandez felt compelled to leave her parents there because her mother had dementia and needed stability in her final years.

Her father died about seven months into his care on July 4, 2015, while his wife died eleven months later in June 2016. “In my opinion, I think better care would probably have kept them here,“ Hernandez said. They both passed away in a nearby hospital due to natural causes.

Alexandria Care officials declined to comment.

A new bill in the legislature aims to increase total skilled nursing hours per day per patient from 3.2 hours to 4.1 hours by 2020. Facilities can request permission for a waiver.

According to a report released this year by the Census Bureau, by 2030 all Baby Boomers will be over the age of 65. This will be the first time in U.S. history where older people are projected to outnumber children. The upcoming “Silver Tsunami“ becomes a compounding issue with the current nursing staff shortage in America.

Garcia believes that many of the issues could be solved if things ran differently. “So it’s a complex morass which could be resolved by the state of California’s Department of Public Health simply stepping up and doing its job.“

He believes that the state has historically refused to fix its problems. “[They] frankly let the citizenry of the state of California down horribly in my judgment.“

An Inside Tour of Bay Crest Care Center

Lynn Cardarelli gives a tour of the facility where her life partner, Joe Wiederhold has been living for three years.

Before The Home

A look at what life was like before entering into a local nursing nursing home.

L.A. County Homes with the most severe citations

This is a map of every home in the L.A. County area that has had at least one kind of the most severe citations. Severities are broken down into four groups of severity codes. The range is A - L, with A being the least harmful to L being immediate and widespread jeopardy.

Yelp Reviews of Alexandria Care Cener & Bay Crest Care Center

What people online have to say about these nursing homes. Here is a small sampling of that conversation.