Shifting population in California nursing homes creates ‘dangerous mix’

David Thompson was living at the Midnight Mission on Los Angeles’ Skid Row when he secured a bed several years ago at a South Pasadena nursing home. For a man who had been homeless for 35 years, the arrangement seemed like a stable step forward.

Instead, he discovered that South Pasadena Convalescent Hospital was visited regularly by local police, summoned to the facility to break up fights or investigate alleged drug-dealing and thefts by residents. Thompson, injured decades earlier in a car wreck, recalled how the nursing home had lots of younger patients with no apparent disabilities.

One resident was known to pack a gun in his wheelchair, he said, a story that is corroborated in state documents. Another patient, he heard, smoked meth in the bathroom – a situation also detailed in state inspection records. Thompson said he kept to himself when fights broke out.

"They had so much stuff going on in there," said Thompson, 79, who since has moved out of the South Pasadena facility and into another nursing home. "I guess the police chief got tired of it."

The turmoil inside South Pasadena Convalescent Hospital became painfully public in November 2014, when one of Thompson’s smoking companions – 57-year-old Courtney Cargill, a mentally ill resident – left the facility unsupervised, doused her body with gasoline and lit herself on fire. After prodding from the local police chief, and a surge of community outrage, the California attorney general’s office opened an investigation into the facility and whether anyone should be held criminally accountable for her death.

The gruesome case also has shined a light on the divergent population groups that inhabit California’s 1,250 nursing homes – and the risks associated with serving such a wide mix of patients.

Where once skilled nursing facilities were universally thought of as "rest homes" for the frail and elderly, a growing proportion of California nursing home residents are younger, more able-bodied patients, many diagnosed with mental illness. Some residents, like Cargill, enter facilities with long-standing drug and alcohol problems. Others, like Thompson, have histories of homelessness. Still others are newly released from prison.

Facilities have been able to tap these clients’ Medicare and Medi-Cal benefits and, in many instances, provide long-term housing at government expense.

"The homes that we have known as havens for the frail elderly, as you can see, are no longer safe havens," said Tippy Irwin, executive director of San Mateo County’s ombudsman services.

Instead, she said, many facilities now have what she described as a "dangerous mix" – old, young, mentally ill, convicted felons, street people in desperate need of care, and younger clients with chronic illnesses, brain injuries and drug abuse problems.

"I don’t think people have a clue," Irwin said. "I don’t think people give nursing homes a thought unless they’re actually faced with having to use one."

Between 1994 and 2014, the population of California nursing home residents under age 65 grew by nearly 40 percent, while the number over 65 shrank by 11 percent, according to a Sacramento Bee review of state data. Today, 1 in 5 nursing home residents in California is under 65.

In California, the number of nursing home residents with serious mental illness also is on the rise. In 2014, the Golden State ranked fourth in the nation for the percentage of nursing home residents diagnosed with schizophrenia or bipolar disorder, behind Illinois, Missouri and Louisiana, according to data collected by the Brown University School of Public Health. The rate of schizophrenia and bipolar disorder in California nursing homes increased by about 60 percent from 2000 to 2014, to 1 in 7 residents, the data show.

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