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El Cajon Nursing Home Reaped Big Profits While Shortchanging Resident Care, Analysis Shows

Speaker 1: 00:00 A key question, hanging over the tragically high number of COVID-19 deaths at nursing homes is do they have the money to do better KPBS investigative reporter or Meetha Sharma reviewed the finances of a local nursing home with a poor care record and has this report Speaker 2: 00:17 Old photos of Irma Eastern show, a young dark haired, luminescent, beauty whose life brimmed with promise decades later, her life ended June 8th when paramedics failed to revive the 66 year old after she choked on powder donuts in her room at avocado post-acute in alcohol. Speaker 3: 00:38 So you didn't have to die this way. They're trained medical staff, the hair. So what are they doing? Speaker 2: 00:44 Eastern starter Beatrice Barrios says an avocado nurse had given Easton a pack of the donuts, then left her alone to eat them. Despite the fact that Easton was a diabetic and needed her food mechanically softened due to a swallowing disorder and a history of choking, Speaker 3: 01:02 Obviously they're not providing proper care. Speaker 2: 01:05 Delivering proper care has been a challenge at avocado KPBS reviewed avocado's financial reports with the help of lawyer, Ernie Tosh. He is a nationally recognized expert on nursing home finances. We found the for profit facility has failed in recent years to provide the level of nursing care expected by regulators, the regulators, the centers for Medicare and Medicaid services published the expected level of staffing and reimbursed avocado based on the needs of the facilities residents yet in 2018, the record show avocado shortchanged its residents 184 hours of registered nursing care per day. Speaker 3: 01:50 I mean, I'm not making it up tomorrow or the next day. It is never going to be made up. Speaker 2: 01:56 Gosh, found the 2018 registered nursing care deficit at avocado was part of a pattern. Avocados shorted its residents more than 170 hours in registered nursing care per day in both 2016 and 2017 avocados lawyer, John Cohn argued in a written statement that the facility staffing ratios of registered nurses were in line with California and national averages, but he never addressed why they were not in line with what federal regulators expected. Taj says CMS is expected. RN staffing levels were meant to ensure that residents received the care they need Speaker 3: 02:39 Are the front line, top medical providers in the facility. When you don't have them there, you don't have anybody that can assess the patient that can determine if they're developing an infection. If you don't have RMS, your healthcare system breaks down in a nursing home Speaker 2: 02:57 Cahtos complaint. History shows that the might have systemic problems from 2017. Through October 5th of this year, 462 complaints were filed against the nursing home. According to the California department of public health, 56 of those complaints were filed this year alone. More than four times, the statewide average Cohn avocados lawyer said many of those complaints were self-reported. He added that given the large size of the 256 bed facility compared to other nursing homes, quote it logically follows that it will have more incidents to report, but nursing home reform advocates say complaints against avocado are still high. Even when factoring size over the years, inspectors have cited avocado for lax infection control, abusive residents, falsifying records, and failing to keep the place free of hazards. Avocado has also had the second highest number of residents who tested positive for COVID-19 among nursing homes in San Diego County. Speaker 3: 04:06 The core issue is that there's inadequate staffing at this facility. Speaker 2: 04:10 Brian Lee is executive director at the Texas based nonprofit families for better care. The residents end up separating by understaffing registered nurses. Tosh calculated that avocado has saved $1 million or more annually from 2016 through 2018. Yet avocado has brought in more than $3 million in profits in both 2017 and 2018. Speaker 3: 04:35 When you're making three to three and a half million dollars a year in profit, you could staff property. This is not a facility that can stand up and say, we didn't have the money to do this. Speaker 2: 04:47 Meanwhile, the California department of public health investigated Irma Easton's choking death and told her daughter Beatrice Barrios, that avocado was not at fault. Bearius doesn't understand that conclusion. Speaker 3: 05:02 They didn't help her. They didn't provide her assistance in the moment that she needed most. She died in the most painful, horrible way that I can imagine that she would die. Speaker 2: 05:12 Amica Sharma KPBS news. Speaker 1: 05:14 Joining me is KPBS investigative reporter Amica Sharma Amico. Welcome. Speaker 2: 05:19 Thank you, Maureen. It's good to speak with you. Speaker 1: 05:22 The report we just heard is the second of two reports focused on nursing home care and revolving around avocado post acute. Now, yesterday we heard about a 73 year old resident who was allegedly sexually molested by an avocado employee and that same employee then went on to allegedly molest a resident at another nursing home and ultimately lose his state care license. My question is Amica, who has the ultimate responsibility of protecting residents in for profit nursing homes will the administrator of the does. Speaker 4: 05:59 Um, but if the administrator fall short, it's the job of the other layers of regulation to come through. And by that, I mean the California department of public health, which inspects nursing homes that are federally funded through Medicare and Medicaid, um, and those inspectors act on behalf of the centers for Medicare and Medicaid services. So they go into a nursing home and they inspect what's going on. They investigate incidents like this, but Maureen, let me just say something about both the California department of public health and the centers for Medicare and Medicaid services. Again, they are the regulators of these nursing homes. I have not found the CDPH or CMS to be very communicative. They have underperformed in answering questions in producing data and producing relevant data in a timely and complete way. And at any point in time, I don't know that their data is reliable. And this is happening at a time when people are deeply concerned about their parents, about their loved ones in these nursing homes and information coming out of CDPH and CMS is critical. It's absolutely critical. Well, I was really surprised Speaker 1: 07:23 At the center for Medicare and Medicaid services. Doesn't do audits of these nursing homes that are mostly operating on Medicare money. Is there any agency that watches out for fraud at these facilities? Speaker 4: 07:37 No. We asked a very specific question about that and they said they do not perform audits. And by the way, that's backed up by lawyers who represent families, suing nursing homes. Speaker 1: 07:50 Now the alleged victim of that assault is suing the facility. What does she hope the lawsuit will achieve? Speaker 4: 07:58 Well, I think she has two goals. One of which she mentioned in the piece, she believes that the people who didn't properly report the sexual assault didn't properly report what allegedly happened to her should never be allowed to work in nursing homes. Again, she thinks that's justice and she wants the caregiver who allegedly did this to her to be charged by prosecutors. Speaker 1: 08:24 Now today's report the report that we just heard focused on the discrepancies between staffing levels claimed by avocado and the actual hours of care the residents are receiving your report seems to indicate that this isn't a mistake on avocado's part, but couldn't be a deliberate misrepresentation in order to save money on care. Speaker 4: 08:47 Well, if it's a mistake, maybe the figures that they represented in terms of what they provide or how many hours of nursing care they provide, their residents would have happened in one year, but for three years in a row, avocado said that each of its residents received a total of 5.2 hours of total nursing care. And when you look at the actual hours worked, that's something that was not the case. Speaker 1: 09:18 You know, I'll bet. Most people don't realize that nursing homes are viewed as great investment opportunities. Had you heard that before? Speaker 4: 09:26 I had not, but I've never really covered this area before. And in terms of being great investment opportunities, this is a situation that has really developed over the last two decades. So now you have a bunch of large nursing homes, um, that are basically chains and they are publicly traded companies. And in even those that aren't are owned by private investors or private equity companies, and they have all created these layers of corporate ownership. They have their own management companies, uh, they've put their property in limited liability companies or trusts is to limit legal liability. And of course it's beneficial to them tax wise, but where does this leave resident care? When the overriding goal of nursing homes is now profits for owners, profits for investors. So you left with a situation where quality of care takes a back seat. And as our stories demonstrate regulators, aren't really regulating. Speaker 1: 10:36 And I suppose the question that people are left with is how can an individual or a family member figure out if a care facility has the staff and track record to be entrusted with the care of a vulnerable person? Speaker 4: 10:50 Well, that's just it, I mean, you nailed it in terms of your question. There is no reliable source, other than word of mouth, your gut, lots of shopping around, um, asking a lot of questions. You can go to the state's website, the CDPH website to find out how many complaints have been filed against the particular facility. Um, and then compare it to other facilities, but it's still a very difficult process to figure out. And, and there's certainly no guarantee that after completing that process, that you were going to be able to find a quality facility for your loved one. Speaker 1: 11:30 I've been speaking with KPBS, investigative reporter Amica Sharma Amantha. Thank you very much for this. Thank you, Maureen.

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In recent years, residents at Avocado Post Acute provided its residents with far less care from registered nurses than regulators expected while reporting millions in yearly profits, according to a KPBS analysis of its finances.
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