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Vulnerable 

Has anything really changed in Humboldt’s nursing homes?

Part one in a series 

If a black hole could compress a lifetime, could mangle and crumple it down to a few essential remnants, they might look like these: A harmonica. A great-grandson's photo. A painted, prayerful Jesus. A stuffed cat.

These are what's left of the wild days, the now unmentionable tattoos, the jobs, the kids, the marriages. These are what people cram into the nursing homes of Humboldt County: A whole life, somehow crunched into a room, or half a room, or an aisle beside one of four beds.

Even if you love the place, the way Marcia Murray says she loves the Eureka Rehabilitation & Wellness Center, its limitations are inescapable.

"This is it. I can't walk but a little ways," says Murray, whose lung problems force her to hang oxygen off her wheelchair and sleep with a special mask. "You can't go camping. You can't go swimming." You can't own a dog, or go to the zoo or even count on wearing your own clothes, because they might turn up on someone else's back after laundry day. And then you feel bad about asking for them.

"This is it," Murray says again.

"Once in awhile I get down ... and I cry."

About 450 people can be housed in the five skilled nursing facilities near Humboldt's coast, places that have gone on a legal ride so wild it made headlines around the state, shocked an industry, burnished careers and changed regulations. Now that it's over, these people are in the hands of a new stranger: A mystery company called Brius. Some nursing home residents say they don't notice any difference at all.

 

The lawyers who started it all wanted to make a difference. So did the jury.

When their verdict came down last summer, it slammed with staggering force at Skilled Healthcare Group Inc. At the time, the sprawling company owned just about everything that mattered to a frail older person in Humboldt needing 24-hour care. It had five of the county's six nursing homes. The only exception was a community hospital in Garberville with 17 beds for people needing skilled nursing.

At the end of a massive class action suit, a Humboldt County jury found that Skilled had failed to provide the minimum number of nursing hours not just in Humboldt, but in 17 of its other California homes. It concluded that Skilled stinted on care for so many people, over so many days, that the damages should be $677 million -- before the next phase of the trial, which theoretically could have trebled that into the billions.

"What we wanted was to send a message to the whole United States nursing home industry," jury foreman Bob Hart recalled last month. "You can't put the bottom dollar over people."

The trial never entered its next phase. Instead, the lawyers who had gone after Skilled went straight into settlement talks. If they had done anything else, Skilled told them it would declare bankruptcy, attorneys involved say. The talks were long and bitter. In the end, Skilled admitted nothing and agreed to pay less than a tenth of the original jury verdict. Around $50 million would be divvied up among legal fees, nonprofits or agencies that help seniors, and people who lived at Skilled when it was understaffed -- or their survivors. Skilled would be credited for setting aside another $12.8 million to pay for close observation by a special auditor, under a court injunction.

The injunction was the crown jewel. It was so crucial that the team behind the class action suit would have been willing to settle without ever going to trial if only Skilled had agreed to similar outside monitoring, said Tim Needham, one of the Eureka lawyers who launched the case.

Under the injunction, all 22 nursing homes would have to submit monthly reports for two years, showing that staffing reached minimum levels required by the state. Every three months, four of the homes would be randomly chosen for detailed audits. Advocates for people in nursing homes praised this tough oversight. Needham and his colleagues began racking up lawyer-of-the-year awards that are still coming in.

There was just one problem with the settlement showpiece. A new operator would not have to comply.

Looking back at it now, the prosecutor who intervened in the class action suit is rueful. Sitting in his office beside an elaborately carved desk, the view of Humboldt Bay shrouded by blinds closed to cut the glare, Humboldt County District Attorney Paul Gallegos pauses and thinks for a long time between answers.

There might have been ways to structure the settlement differently, to ensure two years of rigorous oversight no matter what, Gallegos said, but the idea that Skilled might ask someone else to run its homes didn't come up. "We had no reason to believe anything was going to change," he said. Even if he'd known, and tried for something stronger, "it might not have played out like that. They had the bankruptcy card," the threat to drag on for years in a potentially unfriendly courtroom thousands of miles away. Needham remembers being equally blindsided. "I don't think it crossed our minds," he said, that Skilled would slip away in a carefully crafted pseudo-departure. Yet Needham, Gallegos and Skilled's successor all have agreed: The new operator is not required to obey the injunction.

At some point that remains known only to Skilled, it decided to jettison its five Humboldt County operations. Not the buildings, nicely located pieces of real estate in Fortuna, on Humboldt Hill, and scattered along gently undulating streets near medical offices in northeastern Eureka. Just the business of running the nursing homes, the changing diapers and washing bodies and following state laws.

"It's a burr under my saddle," Gallegos said, that the settlement was discounted to cover Skilled's costs of undergoing special scrutiny for two years, and yet now only 17 of the original 22 sites will have to obey. "It angers me," he said.

The new operator took over before the first monthly compliance report was due, before any random audit could take place.

The nursing home licenses traded hands on April Fool's Day.

The metal cage spins, white balls clattering inside it. It's bingo time at Pacific Rehabilitation & Wellness Center in Eureka. Some of the people with the most trouble hearing have angled their wheelchairs close to the caller. He's a bulky man with a kind voice. Between games, he moves among the players, hovering where there's confusion. He gently calls one man's name twice. "Clear your card now. We're starting a new game." He moves to another.  "I'll clear your card."

The dozen or so players cluster in a central polygon beside a nursing station. One man is belted into his wheelchair. A woman closes her eyes and picks her nose. Another player's mouth is oddly askew, jaw drooping to one side.

Light pours into the 10-sided space from skylights above, and a shrill beep is almost constant. The noise comes from a panel across from the nursing station, where a light goes on and an alarm beeps loudly every time a resident pushes a call button. "N 39," the bingo caller proclaims. Beeep. "B 14." Beeeeeep.  

On this Friday afternoon, others doze in wheelchairs parked on what staffers call the circle, the hallway that surrounds the polygon. Its carpet was once green and yellow, but now is riddled with palm-sized splotches of paler yellow. The air is faintly stale, and the noise is inescapable, from the beeping alarm, from hallway conversations, from surrounding rooms. It's July 15, and little bits of red, white and blue glimmer on the walls.

Since the new operator took over at Pacific, Marjorie Davis hasn't noticed any changes. Davis is president of the residents' council, the group that works with local administrators on residents' questions and complaints. Mostly, at Pacific, they have to do with call buttons. Staffers try to answer them quickly, she says, but don't always manage to. "They do their best," Davis says. "It just all depends, if they're real busy or what. ... Sometimes they don't have enough aides." She is wearing a tie-dyed T-shirt with a peace symbol stretched across the front. In her view, Pacific has sensible rules, and she tries to follow them. "I don't get in trouble. I try to behave myself and maintain."

Her roommate, Joan Turk, thinks the change has made some difference at Pacific. "If we turn the light on, people come faster." Back awhile, she thinks maybe six months ago, Davis fell and Turk tried to help her up, but wasn't strong enough to manage it. No one responded to the light. She had to go into the hallway to get help. Davis recalls being unhurt except for a little bruise.

The delay between a plea for help and its arrival cannot be severed from staffing -- the simple math of how many people are around to respond. For nursing homes, staffing problems make the headlines when someone wanders away and dies or when a bedsore expands into a lethal infection. For residents, dependent on others to get a drink of water, pick up something they dropped, or use a toilet, short staffing can also mean a daily stream of small irritations. In 2007, a New York Times investigation laid some of the blame for short staffing at the feet of large, private investment firms that had been buying up nursing homes, cutting costs and changing ownership structures to make it harder to sue. Under such owners, the Times found, residents had higher rates of depression, less mobility, and lower scores on many other health measures used by federal regulators, such as the preventable infections. "Byzantine" ownership structures, sometimes involving more than a dozen companies at one site, can throw roadblocks in front of regulators or anyone else who wants to prevent abuses or track down their perpetrators. That is a deliberate strategy to contain what investors see as frivolous lawsuits, the Times reported. Arnold M. Whitman, then a principal with an investment fund that bought into nursing homes, told the Times: "Lawyers were suing nursing homes because they knew the companies were worth billions of dollars, so we made the companies smaller and poorer, and the lawsuits have diminished."

 

Brius is trying hard to look small. When the homes' new operator came to town, one of its vice presidents, Brad Gibson, hit the local note hard. He made a point of telling people he was born in Humboldt and started his nursing home career here. Things are "back in local control," he said in a Times-Standard interview published in early May. Brius would have a regional office here and would try to buy locally. "We want to give them the feel that this is a local company," he was quoted as saying.

Brius is not local. It's not even close to local. If you look a bit, it's hard to tell just what it is at all. A Skilled press release describing the change said the five homes were going to be run by Brius Healthcare LLC. In conversations with the Journal, Gibson called that "one of the DBAs," a doing-business-as name, for Brius LLC, the company for which he says he is vice president of operations. Yet his business email goes elsewhere, ending in rockporthc.com. Oh that? "Rockport just does some of the administrative services for the facilities," Gibson said. On Humbolt Hill in Eureka, where the Seaview Rehabilitation & Wellness Center sits on a low rise sheltered by pines, a certificate near the front door identifies the owner as "Rockport Healthcare Services." That, said Gibson, is a mistake he will have fixed.

Brius has no website, no corporate mission statement, no online list of the properties it owns. This is a deliberate attempt to avoid what Gibson calls branding. "Because it's so regionally based, we didn't take the branding approach," he said. Over the phone, his voice rings with a Norman Rockwell roundness, a tone of firm handshakes, apple cheeks and a straightforward gaze. It is a gosh darn nice voice, even when wrapped around the word "no." Until now, it has been pretty much the only public voice for Brius in Humboldt County. With one exception, Gibson initially instructed administrators not to speak to the press, directing all calls and questions to him.

Asked for three days running to provide a summary of what the company owns, Gibson first delayed, then said he wasn't sure a full list existed, then said only the chief executive officer Shlomo Rechnitz would know. He offered to "find" a number for Rechnitz, then backtracked a few hours later. "He's asked not to have that disclosed," Gibson said. "He's very low key." Gibson said he'd pass along a message that a reporter would like Rechnitz to call. A receptionist at another Rechnitz-commanded company said the same. Day after day, the phone number that a nursing home trade group lists for Brius rang 11 or 12 or 13 times, before being picked up by a fuzzy recording saying, "Your party is not answering. Please try your call later. We're sorry, but your call will now be disconnected."

The ice broke after 11 days. Writing from a new email address, this one ending in "briushealth.com,"  Gibson typed, "Shlomo Rechnitz, the CEO of the company, is available to chat today if you'd like."

 

The walls that surround Marcia Murray are lavender, dappled with butterfly stickers. She pronounces her first name Mar-SEE-uh, and has a smile as sweet as that soft, added syllable. Now 66, Murray likes to tell visitors about the day she decided to move back to California, the day she took one look from an airplane window, saw whales in the Pacific, and knew she was done with Colorado. As she speaks, a woman's voice rises and falls from the hallway in a stream of incoherence. "God help her," Murray says tenderly. "When she's not asleep, she's moaning, crying out. And she's disabled." Murray knows the sounds at the Eureka Rehabilitation & Wellness Center, knows the nurse's dog that will cuddle in her lap, knows everyone, and tries to love them. "I am not kidding, I love it here," she says. "I love the people here. Mary is an angel." That's Mary Johnson, the home's administrator, who Murray says made sure her room was painted lavender before she arrived.

Murray serves on the Eureka Rehabilitation residents' council, where she says the most common complaint is from residents who aren't taken outside for smoking breaks whenever they ask. She notices little difference between Skilled and Brius -- they both employ the same people, people doing the very best they can. The only thing new that Murray notices is now, staffers cluster around the time clock, waiting to punch it at exactly the right minute before starting their shifts.  

Over three days, from July 14 to 16, the Journal met with residents' council members at all five Brius homes, and with others introduced by staffers and residents. At Gibson's invitation, with a promise to photograph only those who signed releases, a reporter watched bingo games, group exercises and gardening time. At home after home, staffers called everyone by name, trying to re-direct the confused and engage those who dozed off during activities. Residents who were able often came to each other's aid, whether giving directions or quickly alerting a nurse to a man trying to lurch unsteadily out of his wheelchair.

Physically, the five homes are different. At least three of them have outdoor gardening areas with planters at wheelchair height. Several have recumbent elliptical exercise machines. A couple have semi-private patios that residents have decorated with birdfeeders or flowers. During those initial visits, only two smelled noticeably of urine, Seaview in an exercise area and Pacific's back hallways.

The five places are also the same. They share a racket, a constant hum of conversation, televisions, beeping machinery and the more than occasional string of incoherent shouting. They share the people who cannot be interviewed, who sit propped in bed or in a wheelchair, who shuffle in a daze. They share a series of minor complaints, according to residents' council members: slow but never outrageously long responses to call buttons or lights, food too hot or too cold, loud neighbors. And they win almost uniform praise from anyone willing to have his or her name in a newspaper. The staff are angels. They are like family. The place is like a four-star hotel. The food is great. Residents would change some things, if they could: They'd like more outings, more activities (more bingo!) and maybe a few more fresh fruits and vegetables.

After the first visits, the phone call came. A resident wanted to say more and say it privately, where nursing home staffers couldn't overhear. "You were being steered," the caller said, to the people who never complained. Residents are suffering, and it's being blamed on short staffing.

Then the line went dead.

Continued next week

 

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About The Author

Carrie Peyton Dahlberg

Bio:
Carrie Peyton Dahlberg was editor of the North Coast Journal from June 2011 to November 2013.

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