The day before Kimberly Holdford left on a camping trip with her husband and twin girls in June of 1997, she stopped by a nursing home to visit her grandmother. It had been a month since Jewel Elizabeth Forester entered the Beverly Health and Rehabilitation Center in Jacksonville, Arkansas, to recover from a bout with the flu that had left her severely dehydrated. She hated the facility. Beverly aides seldom bathed her and often neglected to take her to the bathroom, leaving her caked in dried feces and sobbing in shame. Holdford didn’t know what to do; Beverly was the only nearby nursing home with an available bed. “We’re understaffed,” she recalls an aide telling her. “We don’t have enough people to do the job.”
At 80, Forester remained feisty and sharp-witted, tackling crossword puzzles and reveling in the afternoon soaps. But on the day before the camping trip, Holdford found her groggy and disoriented. “What’s wrong with my grandmother?” she asked the nursing staff. “She won’t wake up.” Assured that a doctor would be called, Holdford reluctantly left for the weekend.
But no one at Beverly called the doctor. The next day Forester was screaming in pain and moaning in her sleep. Aides tried to calm her down because she was disturbing other patients. On Monday a respiratory therapist found Forester nearly comatose. She was rushed to the hospital, where doctors found three times the maximum therapeutic level of a drug called digoxin in her system. The nursing home had administered an overdose of the drug, even though it had been warned that Forester had trouble tolerating the medication.
“What followed was nine days of the worst deathwatch you ever saw in your life,” recalls Robert Holdford, Kimberly’s husband. “She was screaming and moaning as her organs shut down from the overdose. She suffered an agonizing death because of Beverly.”
Nor was Forester the only patient at the home to suffer from substandard care. With too small a staff to turn and feed them, some residents developed bone-deep wounds; one was hospitalized weighing only eighty-one pounds. Last September a 58-year-old man died after an untrained and unlicensed nurse punctured his stomach lining when she tried to reinsert a feeding tube.
Dan Springer, a vice president at Beverly, calls the facility “an aberration,” but the company has acknowledged that things were seriously amiss. “We knew that we had some problems,” a top executive told reporters after the home was finally shut down by the state. “It was horrible.”
Such horror stories involving nursing homes have become almost commonplace. For three decades, federal and state investigations have repeatedly documented widespread understaffing, misuse of medication and restraints, even physical attacks on patients. Yet thousands of vulnerable citizens remain confined in depressing, debilitating–and often deadly–institutions like the one in Jacksonville. Last summer, a federal study found that nearly one-third of all nursing homes in California had been cited for violations that caused death or life-threatening harm to patients. Federal officials charged with policing dangerous homes “generally took a lenient stance,” William Scanlon, director of health financing and systems issues for the US General Accounting Office (GAO), testified before a Senate panel in July. “Homes can repeatedly harm residents without facing sanctions.”
Federal officials are promising to subject nursing homes to closer scrutiny in the coming months. President Clinton has ordered a crackdown on repeat offenders, the Justice Department is investigating charges of fraud and abuse, and Congress is poised to reshape Medicare and other programs that pay for long-term care. Yet such efforts focus more on cutting costs than improving care; they fail to recognize that standards remain lax and reforms fall short because of the very nature of nursing homes. Facilities that care for nearly 2 million elderly and disabled residents form a lucrative private industry that profits directly from pain–while taxpayers foot the bill. Nursing homes ring up $87 billion of business each year, and more than 75 cents of every dollar comes from public funds through Medicaid and Medicare. The less of that money homes spend on care, the more they pocket for themselves and their shareholders. To insure those profits, nursing homes are careful not to skimp when it comes to investing in politics: The industry gives millions in contributions to state and federal officials, insuring weak public oversight.