California Armenian Home once again snubs an Armenian Fresno Leader

 

Once again Ms. Yuba the Nazi has snubbed a Fresno Armenian leader, but this time it was just not any leader.  This woman was responsible for donating the money to erect a flag pole which houses the Armenian flag at the entrance of the California Armenian Home.  To spare her name and her family's privacy we will refer to her as her initials "AM".   "AM" 's family had called to have her admitted to the California Armenian Home.  They were rejected because the 150 bed hospital that she donated THOUSANDS $$ to claimed "We are full"

 

Maybe full of shit!!!

 

The real truth is the hospital namely Yuba the BLACK snake doesn't want Armenians in the hospital that have family checking on them.  "AM" has a daughter that is diligent and would have been watching every move of this staff. 

 

Never fear Yuba, it will cost you in more donations $$$ as your hospital slips further into the hands of non Armenians this wealthy Armenian woman "AM" is in a private home operated by Armenians. You see Yuba, aka the Black Snake....we have our own living facilities in Fresno County and won't be needing your services any longer. 

 



California Armenian Home, 50 things Nursing Homes do NOT tell you.

50 Secrets a Nursing Home Won't Tell You

What you need to know—but probably don't—to ensure that your loved one is happy, cared for, and safe.  If you want them REALLY safe and cared for do home health care, and never put your parent in a place that blocks them from leaving and going home or to another nursing home by writing incorrect data on their records by a bunch of illiterate LVNs with no degree, and no sense. 

Unprofessional LVN like Lori Quinn, cannot find a job anywhere else
will still be around when the place is sold, she comes cheap with the building. She is dangerous and
should not be around elderly patients who need someone that is trustworthy not that comes cheap.   

Sally Llanes/Getty Images

• How do you know it’s time to start looking at nursing homes for a loved one?

"If you have concerns about safety, about his being able to keep track of his medications, about whether he’s eating enough and eating healthfully, he’s probably ready to go. It gets to a point where you have to say, ‘This can’t go on any longer.’ ”—Richard L. Peck, former editor of Long-Term Living magazine and author of The Big Surprise: Caring for Mom and Dad

• "The best time to visit a nursing home you’re considering is 6 p.m. on a Saturday. Dinner has been served, few if any managers will be in the facility, and it’s likely that no marketing people will be there. You’ll get a true picture. Talk to staff and family members of residents about what they like and don’t like.”—A California nursing home administrator

• “Consider the noise level. Most nursing homes have double rooms, with two patients, each with her own TV, often with dueling channels on, blaring. Sometimes you’ll hear odd cries and calls from residents. Older homes have overhead paging systems that everyone can hear; newer ones have wireless devices that are much less obtrusive. Take a moment on your tour to just listen.”—Richard L. Peck

• “What should you look for? I always say staffing, staffing, staffing. Our recommendation for a daytime staff-to-patient ratio is one to five. One should be a direct caregiver, like an aide. We recommend one to ten during the evening shift, and one to 15 overnight. If you have residents with dementia who need lots of monitoring, you need to staff up.”—Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care

• “If it smells like urine, that’s obviously a bad sign. But if all you smell is pine cleaner, I’d be a little suspicious about that, too, wondering what odors it’s covering. What you want the place to smell like is a clean home, with no strong scent that’s good or bad.”—Richard L. Peck

Jacek Fota/Anzenberger/Redux

• Make sure you also visit during mealtime, since in some places it’s so busy that it’s common for residents to not get enough food or drink.

"Otherwise, it may take several weeks for you to figure that out, and your loved one may already have lost weight and be undernourished.”—Charlene Harrington, RN, PhD, professor emerita of sociology and nursing at the UCSF School of Nursing

• “Check out the activity calendar. It shouldn’t have only bingo and movies with popcorn. I personally love to see entertainers listed, especially comedians and musicians. And the musicians should sing more than ‘Row, Row, Row Your Boat’ and other children’s songs.”—Marc Halpert, vice president of business development at Extended Care Consulting in Evanston, Illinois, who works with 15 nursing homes

• “Hospital discharge planners will tell you you’ve got 24 to 48 hours to find a nursing home and get out. That’s not true; they need to give you time to make appropriate arrangements. They’re trying to get you out the door because the hospital is paid a flat fee, so if you stay five days instead of three, it’s going to cost the hospital more money. Take the extra time to find a place that offers high-quality care.”—Charlene Harrington

• “The marketing person or admissions director will probably give you the tour, but try to meet the director of nursing, the administrator, and the executive director too. Ask how long they’ve worked there. Ask how long their predecessors were there. If it’s less than six months, and you see a pattern, that should be a concern; high administrator turnover can be an indicator of a lower quality of care.”—Jody Gastfriend, Vice President of Senior Care Services at Care.com

• "Nonprofit nursing homes and government-owned facilities have better staffing, pay better wages, and offer better quality care than for-profit nursing homes. I analyzed all types of nursing homes across the country, and the large, for-profit chains had the worst staffing and were cited for the highest number of deficiencies and severe deficiencies.”— Charlene Harrington

Photo by Kara Newhouse via Flickr

 



Yuba's classy Activities Director Angelica
Rodriquez, the token brown noser to Yuba. 
One of the many reasons Armenians no longer
use this home or will donate to it.  Shad Amot
They have run our hospital into the ground. This
Pig hires only Mexicans to work with her.  Racist will
not hire white people, (not that they would work for her) 

• I’ve worked at for-profit and nonprofit nursing homes.

"If a resident of a for-profit facility says, ‘I’m a Medicaid recipient, and I need a new battery for my wheelchair,’ I have to go through an extensive process—and, in the end, Medicaid still might not cover it. At a nonprofit, I can just go buy it.”—Matthew Maupin, health facility administrator at Lutheran Life Villages in Fort Wayne, Indiana

• “They say you’re not supposed to become attached, but you can’t help it. You do. A lot of times, the CNAs [certified nursing assistants] are fighting for the resident’s rights. If a resident needs help walking, we’ll be the ones pushing for physical therapy.”—A CNA in Wisconsin

• “There was one lady who came from a very poor family. The only gift they’d been able to buy her growing up was rock candy. Because she remembered that so clearly, every time we would give her a sucker, she was absolutely delighted. So we got a giant bag of suckers and gave her one at least three times a day because we loved to see her eyes light up.”—A CNA in Wisconsin

• “I had a patient with ALS, or Lou Gehrig’s disease. She couldn’t talk, had difficulty swallowing, and was on a pureed diet. But she loved crab Rangoon, and we would order Chinese food. We weren’t supposed to give it to her, but she knew the risks and that’s what she wanted. She was always so thankful, and her family thanked me too. Sometimes, at the end, you have to go for quality of life, not quantity of life.”—Registered nurse who worked in a Massachusetts nursing home for two years

• “Right now, federal law requires 75 hours of initial training for a CNA, though some states require more. Dog groomers get more training; nail technicians get more training.”—Robyn Grant

Photo by Brian Bullock via Flickr

• The staffing information collected by Medicare and included in the Nursing Home Compare database is self-reported and not audited.

"That’s like asking people to self-report their highway driving speeds.”—A California nursing home administrator

• “Many nursing home employees are so poor they receive Medicaid for their own health care. The low salary forces a lot of them to work two jobs, so they may finish the day shift at one nursing home and report to another facility to work the night shift.”—A California nursing home administrator

• “Find out if the nursing home uses agency nurses and how often. Nursing homes usually use them when they’re desperate for staffing. Sometimes, the nurses have never been oriented in that facility, and they come in and have to care for 30 or 40 residents they’ve never met before.”—Registered nurse who worked in a Massachusetts nursing home for two years

• “Some facilities have an unwritten rule that if a nurse or CNA calls in sick, that person is not replaced. That saves facilities money on their largest expense: staffing.”—A California nursing home administrator

• “We have to do something about wages. These are the people who are responsible for the lives of our parents and grandparents, and we’re paying them as little as $8.50 an hour.”—Martin Bayne, a longtime advocate for the aging who entered an assisted living facility at 53 after he was diagnosed with Parkinson’s disease

Photo by Jeffrey Smith via Flickr

A nursing home should never tell you that you need to hire your own private aide.

"The home is required to provide all necessary care. If you need extra help, administrators are obligated to provide it.”—Eric Carlson, directing attorney with the National Senior Citizens Law Center

• “Nursing homes certified for Medicare and Medicaid are not supposed to discriminate based on ability to pay. But they’re allowed to take only people for whom they can provide adequate care. So if you say your mother can afford only one month of private pay, and someone else says he can do private pay for six months, who do you think they’re going to take?” —Pat McGinnis, executive director of California Advocates for Nursing Home Reform

• “People don’t realize that Medicare does not cover most nursing home stays, just acute-illness episodes [after hospitalization] up to 100 days. If your loved one needs anything more than that, she’s paying out of pocket, almost $90,000 a year—basically until she’s poor and qualifies for Medicaid.”—Richard L. Peck

• “Long-term-care insurance can make sense, but, unfortunately, it’s best to buy it in your 40s, when you have kids to support, college tuition to save for, and the inevitable home and car payments. By the time you really start thinking about it and you’re around 60, you’re talking about $3,000 a year in premiums or more. And then it really pays only $150 a day, which often is not adequate.”—Richard L. Peck

• “In some states, a nursing home can say, ‘We have 100 beds, and we want only 20 of them to be in the Medicaid program.’ So if you run out of money, and those 20 beds are full, you may have to leave, even though you’re in a Medicaid- certified facility. So as you get closer to the time when you need to apply for Medicaid, talk to staff about whether there will be a bed available.”—Robyn Grant

Photo by Susan Sermoneta via Flickr

If your mom goes into a nursing home, it can’t require you to pay out of your pocket for her.

"Still, nursing homes will send relatives a bill and say, ‘You have to pay us,’ and families don’t know—so all too often, they pay.”—Robyn Grant

• “My No. 1 piece of advice? Visit often. Research shows that residents whose families are involved get better care.”—Jody Gastfriend

• “The nursing home has to develop a care plan for each resident. Ask the staff to hold care plan meetings, and make sure you participate. Have them put into the plan any promises they make, even simple things like giving your loved one a baked potato once a week.”—Brian Lee, executive director of Families for Better Care

• “Elect one family member to be the representative to the nursing home, even if that person doesn’t legally have power of attorney. Otherwise, we’re not sure whom to communicate with.”—Matthew Maupin

• “At some nursing homes, your loved one may see a different caregiver almost every day. What you want is the same caregivers assigned to your loved one on an ongoing basis. When that happens, the aides get to know the resident’s needs, and it translates into better care.”•Robyn Grant

Photo by Susan Sermoneta via Flickr

Medication errors are a big issue.

"Residents who are mentally competent should ask before they ingest anything, ‘What is this? How much are you giving me?’ Know what your relative is taking, how often they’re supposed to get it, and who’s giving it to them.”—Pat McGinnis

• “Nursing home doctors can have hundreds of patients; they usually visit each nursing home once a month. So the nurses line up the charts, and the doctors sign a bunch of orders and make quick visits. Most of the medicine practiced in nursing homes is over the phone.”—A California nursing home administrator

• “Families and residents talk themselves out of complaining because they don’t want to create trouble. Remember, the nursing home is getting paid thousands of dollars a month by you or someone on your behalf. You shouldn’t apologize for wanting some attention and a high level of care.”—Eric Carlson

• “Once you go into a nursing home, you probably won’t be able to see your favorite doctor anymore. Usually, the physician assigned to the facility takes over. Ask how often the physician sees residents, what happens if there’s an emergency, and if the physician is easily available.”—Jody Gastfriend

• “Ask about the pain management policy. Some nursing homes are wary about giving strong medications for pain, and unnecessary pain is a common problem. You want to hear that they do take active steps to decrease pain and that they’re not afraid to use narcotic medications in cases of acute need.”—Richard L. Peck

Photo by Diane Cordell via Flickr

When you’re moving in loved ones, make sure they bring their own pillows and their own bedding.

"I’ve even had families bring an entire bed or a much-loved recliner. Whatever they love most in their home, bring those things if you can.”—Marc Halpert

• “Try to display interesting items in the room to stimulate conversation. That way, when a staff member comes into the room, he’s not just talking about care and when the next shower will be. He can ask about your loved one’s military service or the dog she has a picture of.”—Matthew Maupin

• “It’s a good idea not to visit for the first two weeks, especially if your relative has dementia. Just call, or write a letter if you want to. That gives her time to build relationships with the staff and other residents and get used to the fact that this is her home. Otherwise, every time she sees you, she’ll think she’s going home, and when you leave, she’ll get really upset. It ends up taking longer for her to adjust.”—A CNA in Wisconsin

• “This is your loved one’s home. He should be able to get up and go to bed when he wants to, to eat dinner when he wants to. A big difference between a mediocre or bad nursing facility and a good one is the extent to which residents have their preferences accommodated.”—Eric Carlson

• “We can anticipate with reasonable certainty when we’re going to have our next annual inspection. So some facilities staff up and buff up—paint, wash the windows, get flowers—because they know they have company coming.”—A California nursing home administrator

Photo by David Levinson via Flickr

That paperwork we do? It’s really useless.

"The way it’s supposed to work is that every time you do something, you check it off a list. But there’s no time for that. So you do your job all day long, and then, at the end of the day, you try to remember everything you did so you can go back and check each thing.”—A former CNA who worked in nursing homes in North Carolina and Massachusetts

• “Theft and loss are a big problem in nursing homes. Rings are taken off people’s fingers. Or you give your relative a new nightgown for Christmas, and then it’s gone. Make sure you put your loved one’s name on everything, and that everything is listed in inventory and in the records.”—Pat McGinnis

• “Here’s a big secret: Some nursing homes don’t tell families that having a hospice worker come in is an option because the reimbursement rate goes down if the home has to share the money with hospice.”—Diane Carbo, RN, a nurse in California who worked in nursing homes and assisted facilities for over 20 years

• “Some nursing homes don’t have liability insurance, so it’s difficult to make a recovery if your loved one is harmed or killed, even if you have a good case. Also, the way these facilities are set up makes it difficult to recover anything from the owner. Often, the guy who’s making millions from the facility is virtually untouchable.”—Jonathan Rosenfeld, a Chicago attorney who specializes in nursing home cases

• “When you receive your stack of admissions paperwork, you’ll find the nursing home has snuck in these things called binding arbitration agreements. Basically, the home asks you to sign away your constitutional right to due process, your right to sue if anything happens. So don’t sign it, or say you’ll sign it only after your attorney reviews it.”—Brian Lee

Photo by Ann P via Flickr

One of the best-kept secrets is the long-term-care ombudsman program.

"There’s one in every state, and the ombudsman is your personal advocate to help you in these situations and answer your questions. All the services are free.”—Brian Lee

• “The baby boomers as a growing aging population have very different expectations from the residents we were accustomed to taking care of. We’ve had to start serving stir-fry and taco salads in the dining room, and I have residents who come in with iPads and cell phones who listen to rock ’n’ roll and hip-hop music.”—Matthew Maupin

• “One of the big trends in nursing homes is changing the culture to get away from the institutional perception. We don’t use the word facility, we’re a community. We don’t have a dietary department, we have a dining services department. And instead of units, we have neighborhoods.”—Matthew Maupin

• “People have this image of the nursing home as cold and institutional, and they think, ‘I’m not going there.’ But some are excellent, and I’ve thought, ‘I could live here myself.’ There is warmth and support, company, decent food, and activity directors who keep people engaged and active.”—Richard L. Peck

• “The notion that you get to a certain age and lose your capacity couldn’t be further from the truth. All you have to do is sit down and talk to some of our residents, and you’ll be blown away by their knowledge. I played Scrabble against a 107-year-old resident last year. She was one of my most challenging opponents ever.”—Matthew Maupin

© 2014 The Reader's Digest Association, Inc.

California Armenian Home and the inside scoop............by past and present board members and employees.

 Yuba Radojkovich dubbed "The Black Snake" by the Residents

 

THIS IS FROM THE MOUTH OF 2 FORMER BOARD MEMBERS, BOTH ARE VERY RESPECTED BUSINESS OWNERS IN FRESNO, CALIFORNIA, EMPLOYEES (PAST AND PRESENT)

Yuba Radajkovich, has been at the California Home for the Aged dba California Armenian Home for over 35 years.  In 2005 the board fed up with Yuba and her demoralizing of the home "retired" her out.  A company was hired to manage the nursing home, and there was a short fall of funds to the tune of over $100,000.   At the end of 2006, board member JS-M called Yuba who was at that time living in San Diego and working at an Emmanuel Nursing Home and panicked-  pleaded with her to come back and straightened out the money situation.   The shortfall, according to their state ombudsman Frank Kormazian was because of mis billings to California State MediCaid.  shame shame.

 

Yuba had already ran the nursing home down before she left and was making a concerned effort to remove Armenian employees from any places of employment other than cleaning the floors.  Yuba chased out all the good Armenian nurses (there are many Great Armenian Surgical Nurses and Nurse Practioners) that will not work there or are being paid better wages at the Community Hospital of Central California.  Yuba also drove out any Armenian Physicians as Medical Director and decided to only answer to Armenians on the board, who largely leave after serving on the board 2 years because of politics.  2 pharmacists that are very respected were on the board but will not go near the home and cringe when they see Yuba show up at an occasional Armenian funeral.

Yost and Webb, hates going near the place but offers support for the old time Armenian families that might be in the California Armenian Home.  But that is rare now Yuba is racist and turns away Armenians unless they have money.  But prefers the guaranteed billing of MediCAID, that is over $70,000 a year per resident.

 

There are 150 beds in the Skilled Nursing and Residential section, and approximately 14 are Armenian, 2 Greek and that is it.  Yet Yuba still wants to exploit the Armenian name in hopes of getting more donations $$ from the older Armenians that may have relatives in there.  The Board is comprised of 1 family and a few friends, one that got elected has both his parents in there and JS-M and both her cousins are on the board, as the Bagdasarian clan original donated the land over 50 years and their Aunt C, (and Mother) is still in the home where she has a private room that has been re decorated, as JS-M tries to convince people that "everyone is treated the same"  The other alarming issues besides their Income Tax Returns and the expenditures for the AACL building and upgrades for outer appearances is the numerous nursing home and medical web sites that Yuba refers to herself as a Physician with an M.D. (Medical Doctor) title.  This is being looked at by the State licensing board, but Yuba is shifty and claims she is going to retire and that they "need me"  Well this could be true as none of the board members want to operate the place and work there beyond showing up for board meetings and "if" they know someone in there visiting with them. 

 

 

Yuba returned in 2007 after the money shortfall, and made it her first business to oust the person who was acting as an assistant administrator and part of the recreational duties.  She was a very sweet, very well loved by the residents and college graduate in public administration and organization.  Yuba forced PS with so much stress, backstabbing and mean spirited attitude that PS quit, but did have a case in employment abuse, but chose not to persue it because she had made friends with the residents and they loved her and still talk about her to this day.  Yuba made herself a sweet deal of $150,000 salary with a $20,000 bonus for passing audits.  So far they pass the annual audits but have been fined and cited for many violations from excessive UTIs, to malnurishment and also an outbreak of MRSA and Shingles from cross contamination of resident's clothes that they are forever losing and stealing.  Yuba set out to destroy the nursing home, and kicked all the Armenian supporters out that were left as many had left on their own.  Many of us have heard first had Yuba yell at the employees, with her screeching voice and thick Croatian accent.  If you check your history books, the Croatians sided with the Nazi troops, we were told by someone that knows Yuba very well that her father was a Nazi sympathizer, (no surprise here)

As a result the donations are much lower than 10 years ago and will continue to declne, as there is no connection to the Armenian community except for the "Blessing of Grapes" the churches have on the grounds in August.  But we are told the churches grow tired of paying a fee of $4,000 to use the grounds for this and would sooner have it at the Armenian Community Center (where we have moved our other functions)  AACL(Armenian American Citizen League Building)  membership is down and the hospital uses the AACL building for exercise to include the upgrade of the building in the MediCAID/MediCARE budget but in fact the recent facelift of $500,000 should not be any patient funds that are used on the AACL building

 

Today, Yuba doesn't use any Armenian pharmacists or Rehab, (Rehab L and J Telamansic- her Croatian buddies that are paid $978,000 per year.  No Armenian Attorney wants anything to do with the place (and there is an abundance of them) , so they have an old worn out Attorney that is 76 years old and would never admit himself into the home.  This attorney is so stupid he didn't understand what Hippa violations were. In fact, the nursing facilty was still having visitors illegally sign in with the name of the patient a big "NO NO" and violation of patient privacy that was halted by the federal government.    Yuba is 67 and will be 68 years old in December 2013 she is tired but knows how to milk the system and abuse some of the good workers that have been there 20 years.  They are too afraid to leave and mostly avoid Yuba. 
The newer workers are largely immigrants from India, Mexico and Philippines, 3 are Armenian (1 is from Iran)  and are single mothers....all desperate for money and a job so they suck it up and Yuba hires people that have not had an easy time finding employment and holds their job over their heads in fear, it is a sad place to work.  Now they have added a guard station because there have been so many car break ins, and other thefts.  Quite a few people dump off dogs and cats on the grounds, there have been adorable kitten litters that the residents feed and visit with, but Yuba has the SPCA hall off the kittens (witch)  Some of the workers are very negligent and have openly made what appeared to be drug purchases in the parking lot.  No one wants to get involved or say anything as Yuba wants 100% full control, except the money is running out as far as donations go. 

 

 Most of the elderly are opting for home health care as it is proven that people are happy and healthier in their own homes.  There are 3 home health care agencies operated by Armenians that have a thriving business.  Additionally, there are more newer state of the art facilities being built or completed on the more desirable north end of Fresno: FairWinds, Carrington Point, San Joaquin Gardens, Willow Creek, Nazerene House all great facilities but not without their share of problems.

 

As Yuba continues to down grade the place, and not pay the RNAs more than $12.00 an hour (they are the ones doing the large portion of the work) The RNAs are treated unfairly doing the bulk of the work for the LVN/LPN and a few sprinkling of RNs that largely oversee certain duties/proceedures- that LVN/LPNs are uncapable of doing.   Even the RNs are underpaid at Nursing Homes, the head of Nursing barely makes much more than $65,000 a year.  But as the system goes, once you are locked into a nursing home employment it is difficult to leave.  The head of staff development is a slug named Jan Vawter who has also been at CAH for over 30 years with no where to go.  Jan became an RN under the old "bridge" standards from an LVN with an online college course.  She is a graduate of Clovis Adult School and prefers using Clovis Adult School for hiring and for some of the externing work.  There is nursing students in there all the time.  Getting hours required and not paid.  (free labor).  Finding workers for CAH isn't hard, its KEEPING them that is the challenge.  There are a few employees out of the 100 that have been there longer than 15 years that are outstanding, but they are holding on for retirement, then they are GONE.   

 

Hospitals don't give any more referrals and neither do the churches who largely compete for the Armenian donation money.  Holy Trinity just had a $1 million face lift to the Banquet Hall, there is no way that they will allow CAH to keep that money.  The Der Hayrs (Priests) of the churches make a usual 1 day a week visit, but find there is no Armenians to minister to and feel it is an explotiaton of the word "Armenian" and should be renamed the parent name which is "California Home for the Aged" and take any reference to ethnic background off.  Since the nursing home largely exists on government funding via Health and Human Services, they should take off all references to "Armenian" because of accepting tax supported funds. 

 

 

This downslide of the facilty donations / funds started seriously when Yuba came back in the picture but is declining every year.  There are sadly people in there that don't want to be there and are terribly depressed and on anti-psychotic drugs (nursing homes are notorous for drugging up elderly patients)  many have no family or if they have family sadly...no one is visiting them.  Most of the staff become their family.  There was over 4 falls last year that were serious enough that the ambulance came out. 

St. Mary's Home Health Care is one of the best we recommend you get estimates and meet their staff, that might be in your home.  You can always adjust who it is or increase / decrease hours.  There is also a program via the County that will pay a family member to watch over you.  If you must put a family member in one of these Human Warehouses, watch everything they do, arrive at different times and different shifts, observe any marks on the body, weight change, fever, non compliance with putting hearing aides in, cleanliness of the staff, theft of items.  Know good attorneys and physicians.

This is Jan Vawter, who has been groveling around the California Armenian Home for some 35 years and in 2006 finally became an RN via Excellisor College online.  Woo Hoo.  Jan would leave in a heartbeat if she could find another job, she is eligible for retirement in 20 months. 

 

 

California Armenian Home, California Nursing homes recieved additional $880 million in funding but continue to cut staff and withhold raises.

California’s nursing homes have received $880 million in additional funding from a 2004 state law designed to help hire more caregivers and boost wages.
But 232 homes did just the opposite. They either cut staff, paid lower wages or let caregiver levels slip below a state-mandated minimum, a California Watch investigation has found.
The homes that made these cuts collected about $236 million through 2008, the last year of available data. That's more than a quarter of the total Medi-Cal funding increase shared by the state’s nursing homes. But the law that made the extra money possible included few safeguards to ensure that patient care improved.
Many nursing homes appeared to use the cash infusion to help bolster their bottom lines, according to a California Watch analysis of state nursing home data. Among the 131 homes that cut staff by 2008, the median profit was 35 percent more than other homes in the analysis.

Graphic by The OC Register

At the same time, the analysis shows, about two dozen homes that made the deepest caregiver cuts had about one-third more deficiencies than other state facilities. State inspectors noted a litany of violations that included neglecting bedsores and giving patients the wrong drugs.
“There was an implicit good faith agreement that things would get better … and that was broken,” said state Sen. Elaine Alquist, D-Santa Clara, chairwoman of the Senate Health Committee. “It was broken for the people of California and for a very vulnerable population – those that need the greatest care and those that can’t advocate for themselves.”
James Gomez, the chief executive of the state’s nursing home trade organization, said the 2004 law has led to a 6 percent increase in staffing rates for the state’s 1,100 nursing homes and an overall decline in turnover among caregivers – from 54 percent to 47 percent. California’s homes now exceed the national average for meeting the staffing minimum, Gomez added.
“Is it working in every facility every day? No," said Gomez, leader of the California Association of Health Facilities. “But is it working in total? Absolutely.”
Of the homes that cut staffing, 13 owned by Orange County-based Covenant Care stand out. The homes pared caregivers even as they got $15 million in additional funding.
The average profit at those 13 homes reached more than $900,000 in 2008 – three times higher than the remaining 632 homes analyzed by California Watch.
The chain’s chief operating officer testified last year in a deposition that part of the company’s business plan called for housing more medically fragile patients. The strategy opens the door to higher reimbursements, according to critics, who say it can be dangerous to combine lower staffing rates with patients who need more attention.
Patients such as Charles McGrew.
The Texas-born janitor was admitted to the chain’s Long Beach home, Royal Care Center, in early 2006.
McGrew, a diabetic with high blood pressure and a history of infections, began to develop pressure sores on his ankles and tailbone at the home. But little was done to help him, according to court records filed by his family.
Meredith McGrew, 24, said one sore was like a hole in his father’s back. Seeing it pained the younger McGrew, who remembers his father as a meticulously neat man.
“My family took it really hard,” McGrew said. “My father was the one who looked out for a lot of them and raised them, so they were devastated by the care he was getting.”
McGrew’s left leg needed to be amputated due to one sore, the family alleged. He died three years ago at age 70. His family blamed his death on mistreatment. Attorneys for Covenant said the family failed to prove that the facility caused McGrew’s problems. The case was settled and the terms are confidential.
Since his death, the home’s staffing level sank below the state-mandated staffing minimum set in 2000. Royal Care’s total profits, though, reached $540,000 in 2008 alone.
The Covenant Care chain, meanwhile, rewarded top administrators and nursing supervisors with bonuses based, in part, on how much profit each home generated, records show. Around the same time, a family trust associated with the company’s CEO Robert Levin paid $4.76 million to purchase an Irvine estate, complete with a theater and outdoor living room.
Levin would not comment about funding and staffing levels for this story. He asked in January for questions to be sent to him in writing, but he did not respond to the written questions or several follow-up phone calls. When finally reached by a reporter late last month, Levin again declined to comment.
The funding increases for nursing homes were made possible by the 2004 law that helped the state draw more money out of Washington, D.C., gradually boosting government spending from $3 billion in 2004 to nearly $4 billion in 2008.
The infusion of state and federal money has done nothing to slow the pace of violations and complaints.
State regulators documented nearly 1,000 deficiencies for inadequate care in 2008, a 65 percent increase compared to 2005.
Regulators maintain that the state hired more inspectors, which may account for the increase. But that doesn’t explain the 23 percent rise in complaints filed by patients, advocates or their families.
In 2004, before the law was enacted, nursing homes registered 4,499 complaints. In 2008, patients, their loved ones and advocates filed 5,549 complaints.
Despite mounting complaints and citations, state officials in charge of carrying out the new law granted nursing homes a powerful weapon to fight claims of inadequate care: more money.
They allowed homes to bill the state for legal costs spent to fight fines, citations and lawsuits alleging abuse and neglect.
“The policy is outrageous,” said Michael Connors, an advocate with California Advocates for Nursing Home Reform. “By paying the legal fees of nursing homes that are neglecting and abusing residents, the state is subsidizing their mistreatment. They’re directly undermining the whole purpose of the citation and enforcement system.”
Intended reform marred by lack of oversight
The Nursing Home Quality Care Act of 2004 was designed to fix a glaring problem: Daily Medi-Cal rates paid to nursing homes in California were among the lowest in the nation.
An alliance of labor leaders and nursing home owners came up with a plan that wiped out a flat-fee system and replaced it with one that reimbursed nursing homes based on their costs.
The system allowed nursing homes to boost the amount of matching funds they got from the federal government. The homes first pay a fee to trigger the matching funds and additional revenues.
Not all homes benefited as much as others. Some homes even lost money, especially ones that serve fewer Medi-Cal patients. But most of the state’s homes analyzed by California Watch drew a windfall of new money.
Homes could spend the new money on a variety of services. But reimbursement rates increased if they spent the money on labor. Homes also got additional bonuses meant to boost hiring and wages.
Patient advocacy groups cried foul over the added payment, noting the nursing homes could ultimately spend it any way they wanted. And some advocates bristled over the lack of get-tough measures in the proposal. The California AARP ran full-page newspaper ads that said, “No blank check for bad nursing homes.”
Still, the bill flew through the Legislature. When Gov. Arnold Schwarzenegger signed it, he directed the Department of Health Services to “reward quality care.”
“We are making this investment in nursing facilities to ensure better care, and I intend to hold the industry and caregivers accountable for this critical responsibility,” Schwarzenegger’s 2004 signing statement said.
Despite the governor’s directive, the Schwarzenegger administration failed to follow through.
Instead, California Watch found, state regulators lavished new money on homes where findings of lax care mounted, where administrators failed to pay fines for poor care, and where corporate executives cut staff in California and expanded chains elsewhere.
The governor’s office declined to comment for this story, referring questions instead to agency officials.
Toby Douglas, chief deputy director for health care programs at the Department of Health Care Services, said that most of the state’s nursing homes have invested more heavily in caregivers. His office repeatedly attempted to route questions about nursing home accountability to another state agency that inspects the homes.
While Douglas’ agency sets rates and reimburses nursing homes, a second agency, the Department of Public Health, issues and collects fines for substandard care. Even if one agency cites a home for egregious and repeated violations, the other agency may reward it with more funding.
“Our responsibility is to develop a rate method that tries to meet the goals the governor laid out in his signing message,” Douglas said. “That means we have to set a methodology and hold that methodology accountable. In that area, yes, we believe we’re doing a good job.”
Douglas said the governor’s office has “made it clear that [the funding law] could be improved” by linking nursing home pay to factors such as patient satisfaction, reduction of bed sores or payment of fines for inadequate care. His department is in the “very preliminary” stages of creating such a system, Douglas said.
The effort comes too late, though, according to some advocates. They question whether the state missed a rare opportunity to use the funds to drive systemic improvement.
“Money talks, we know that,” said Molly Davies, director of the nonprofit Wise & Healthy Aging, the Los Angeles elder care ombudsman program. “If you’re going to give extra money, there needs to be an understanding of what the state is going to get in return and what those clients are going to get in return. I don’t think that was made clear.”
The revenue increases to nursing homes were not renewed last year due to opposition from patient advocates, but nursing home executives have been pushing to restore the funding. Alquist, the state senator who heads the health committee, says the law will be scrutinized during a scheduled legislative review this year.
Staffing lags, patients suffer
The Golden State has about 1,100 licensed nursing homes that each year care for an estimated 100,000 people – including the elderly, disabled and those recovering from surgery.

Cindy Yamanaka, The Orange County RegisterPatricia Miller and her three sisters are suing
a home owned by Covenant Care alleging that
the home failed to administer adequate care
to their father.

California Watch reviewed financial and staffing data for the 645 nursing homes, that serve the largest number of low-income Medi-Cal patients who need 24-hour care. The 2004 law was set up to benefit these homes the most.
Of that group, 232 homes either cut staffing or wages or fell below the statewide staffing minimum – even as they received more money from Medi-Cal. The analysis found that 27 other homes fell behind in wages and staffing but saw a reduction in funding.
Since the legislation was enacted, the California Department of Health Care Services gave the 645 homes analyzed by California Watch a total funding increase of nearly 25 percent over five years.
But the lowest-paid workers who perform the vast majority of the patient care in nursing homes did not see that kind of raise. Only 76 homes in the state gave nursing assistants a 25 percent pay increase. Adjusting for inflation, average wages in more than 400 homes went down, the California Watch analysis shows.
In 2008, dozens of homes also operated beneath the decade-old staffing standard – which is set at three hours and 12 minutes of caregiver attention a day for every nursing home patient.
In the homes where staffing lagged, some patients suffered.
Staffing at Cloverdale Healthcare Center in Sonoma County was down 8 percent in 2008 compared to 2004, despite the home’s $1 million increase in state funds. Regulators found problems there in the beginning of 2009, including one patient who had been left wearing a dirty diaper for five hours.
Cloverdale officials did not return calls seeking comment.
Gomez, of the California Association of Health Facilities, said the state should aggressively investigate the homes that operated in 2008 with staffing levels below the state standard.
“I don’t have an issue with them looking at those facilities today,” Gomez said of the 68 homes below the nursing-hour minimum. “That would be the right thing to do.”
The state, however, has not issued staffing-related fines to any of the homes that failed throughout 2008 to reach the minimum staffing level, records show.
Wages rise, but problems persist
Applewood Care Center, a small nursing home in Sacramento, collected an additional $575,000 between 2004 and 2008. But during that same time, Applewood’s ratio of staff to patients dropped 10 percent.
As the money started to flow, Applewood got hit with two serious citations – the first time as a result of lapses in care in the case of Earley Woods.
The 84-year-old grandmother had slipped away into the dark undetected, state regulators concluded. She steered her wheelchair out the backdoor of the nursing home at night, accidentally crashing down a 54-inch flight of concrete stairs in September 2005. Her skull was smashed, her collarbone broken, her wrist was fractured.
About a half-hour passed before Woods was discovered still strapped to her chair which lay atop her. She was taken to the hospital.
Her daughter, Elaine Parham, had just minutes to absorb the shock of seeing her mother, bloody and bruised, before saying her final goodbye.
“This really can’t happen to anyone else,” Parham said in an interview.
Terry Bane, the chief executive of the management company that operates Applewood, said Woods’ death was a “tragic, tragic incident.”
“It … affected the employees in that building in a big way,” Bane said.
Applewood was fined $100,000 after Woods died. The facility pledged to upgrade alarms on doors and improve lighting around the building. It also gave pay increases to nurses, which helped lower the staff turnover rate.
But problems persisted.
In late 2006, one patient was taken to the emergency room for dehydration. Eleven days later, the same 89-year-old woman was sent back to the hospital with “very severe dehydration,” a citation report says.
Several months later, state regulators concluded that the facility did not try hard enough to save a man who died of asphyxiation after food got lodged in his airway.
Regulators cited Applewood $20,000 in the dehydration case and $100,000 for causing the man’s death.
State pays to overturn its own fines
When homes are cited with serious violations, the 2004 state law helps bail them out.
Homes are allowed to bill for administrative costs such as legal fees. That means facilities can charge the state to fight state-issued fines and citations for substandard care.
Advocates say that by doing so, the state undercuts its own efforts to hold homes accountable for lax practices.
“It’s absolutely scandalous that this goes on,” said Tippy Irwin, executive director of Ombudsman Services of San Mateo County. “That’s a gross misuse of state spending.”
State officials also pay legal fees for homes that fight audit findings they oppose. Officials could not identify exactly how much they spent reimbursing nursing homes to fight audit disputes or penalties.
But records show that since the 2004 law passed, nursing homes are challenging twice as many citations. Homes challenged 110 citations in 2005 and more than 220 in 2008, records provided by the Department of Public Health show.
“In this fiscal environment, where the state has no money and all of this is coming out of the taxpayers’ pocket, yours and mine and everyone else’s – this is really unconscionable,” said Alquist, the state senator.

David GrossGary Davis is angry that the nursing home where
his stepfather, Harold Shreifels, died was able
to use state funding to fight a citation for
Schreifels' death.

The arrangement worked in the favor of a small nursing home in San Jose. The owner of Homewood Care Center used state funds to appeal a $100,000 citation issued by state regulators who, in a settlement, agreed to reduce the fine to $5,000.
The citation was issued in response to the events of Oct. 17, 2006. That morning, Harold Schreifels, 67, cried out for help and asked for an ambulance, records show. Staff noted that the diabetic man’s blood sugar was dangerously low.
Yet they ignored their policy to notify a doctor about his condition and dismissed his plea, enforcing a 15-hour fast before a routine surgery.
Schreifels, who enjoyed daily visits from his wife and outings to his grandchildren’s sporting events, never made it. He died an hour before he was to meet his family at the hospital.
“Harold, he had plenty of life in him,” said his stepson, Gary Davis. “If he hadn’t been getting surgery that day he had probably wanted to go see a ball game.”
State regulators cited and fined the home for missing multiple chances to call a doctor or to help Schreifels.
The home’s owner, Jack Easterday, acknowledged in an interview with California Watch that Schreifel’s death might have been avoided if the staff had used an IV to give the man nutrients in the hours before his death.
A mediator discounted the fine $95,000 even though no one disputed that Schreifels’ death could have been prevented.
The state helped pay his legal fees, Easterday said, but he described the state’s contribution as “miniscule.” The state was unable to determine the amount it paid.
Easterday spoke with California Watch at his Oakland office in January, one week before he went to federal prison to serve a 30-month sentence for tax evasion. He was convicted in 2007 of failing to pay the IRS payroll taxes for his eight nursing homes but remained free until he exhausted his appeals, which were ultimately rejected by the U.S. Supreme Court.
Davis, whose family did not file a lawsuit over his stepfather’s death, said he could not believe that the state stood by the reduced fine.
“The government should be … corrected for their mistakes also,” he said. “They’re accountable for their actions, you know?”

http://californiawatch.org/health-and-welfare/nursing-homes-received-millions-while-cutting-staff-wages