ELDER CARE - Bradley Fisher, a 62-year-old retired mechanic, lived in a Bay Area nursing home for 14 years.
Entering at age 39, Fisher had been partially paralyzed when bone spurs severed tendons in his spine. After a few years of rehabilitation, Fisher said, he could have lived at home with proper care.
“You don’t need to be here,” Fisher remembers a certified nursing assistant telling him around 2005, seven years in, as he sat in his wheelchair in the facility’s cafeteria. “You got all your faculties.”
“Yeah,” Fisher replied, “but I don’t know how to get out.”
While elder care advocates sound the alarm about patient “dumping” by some California nursing homes – kicking out their mentally ill or bereft patients who need stable housing and care – a parallel dilemma is also threatening vulnerable residents: how to get out of a nursing home.
The vast majority of people admitted to California skilled nursing facilities stay for less than three months to rehabilitate a broken limb or recover from a stroke or other ailment, according to the California Association of Health Facilities, an industry trade group.
After these short-term stays, residents typically return home.
But for thousands of poor nursing home residents, like Fisher, a temporary stay can become indefinite. Saddled with hefty Medicare copayments that can reach $5,000 a month – and later stripped of Social Security income, diverted to pay ongoing nursing home costs – they are often unable to hang onto their former housing. They become effectively stranded, with Medi-Cal and Social Security paying for housing and daily living in the facility.
Bradley Fisher in the Bay Area nursing home he entered after bone spurs severed tendons in his spine, partially paralyzing him. Courtesy of Bradley Fisher
COVID has only intensified the urgency some residents feel to leave their nursing homes, where more than 73,000 have been infected and 9,522 have died as of Jan. 17, according to the California Department of Public Health. The department and Gov. Gavin Newsom have faced criticism of the state’s nursing home oversight as the public health crisis deepened and the death count climbed.
“Everybody wants out right now,” said Karen Stuckey, who has been transitioning residents out of nursing homes and into the community for 11 years with the nonprofit Choice in Aging. “They’re just there because they have no place to go.”
Over 9% of California nursing home residents, an estimated 37,000, have low-level care needs and could potentially live in the community, according to a 2017 estimate by the American Association of Retired Persons. In the organization’s 2020 long-term services scorecard, which analyzed the quality of life, living options and nursing home transitions in every state, California ranked 35th in “effective transitions.”
Federal regulations require nursing home staff to ask residents four times a year about their health and welfare – including whether they would like to speak to someone about leaving the facility. The requirement was adopted in 2010 by the Centers for Medicare & Medicaid Services, which regulates nursing homes that receive federal money. At the state level, the California Department of Public Health is tasked with ensuring that homes meet both federal and state rules.
If residents answer “yes” to the question of leaving – or ask to leave without any prompting – they are supposed to be referred to a program that can fund and organize their moves back into the community.
But thousands of residents’ appeals for help moving out have gone unanswered.
(Jesse Bedayn reports on economic inequality for The Mercury News in San Jose and CalMatters as part of The California Divide project. Before becoming a Report for America corps member, Bedayn studied investigative reporting and narrative writing at UC Berkeley’s Graduate School of Journalism, where he wrote about health care and aging in California and investigated the fraught world of for-profit nursing homes for the Investigative Reporting Program. Bedayn has worked as a stringer for The New York Times and as a research and data assistant at KQED public radio where he plumbed through police use-of-force cases. This story was featured in Cal Matters.)