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Palo Alto attorney Von Packard has studied the death certificates of all Californians who died in nursing homes from 1986 through 1993. More than 7% of them succumbed, at least in part, to utter neglect--lack of food or water, untreated bedsores or other generally preventable ailments. If the rest of America's 1.6 million nursing-home residents are dying of questionable causes at the same rate as in California, it means that every year about 35,000 Americans are dying prematurely, or in unnecessary pain, or both. The investigations bear out something many Americans have suspected all along: in a recent survey published in the Journal of the American Geriatrics Society, 30% of those polled said they would rather perish than live in a nursing home. Packard, who has spent nearly two years tracking the data, says, "We believe thousands would have lived significantly longer had they been taken care of."
Neglectful caregivers are preying not only on elderly residents but also on American taxpayers. More than $45 billion in government funds, mostly from Medicare and Medicaid, is pumped into nursing homes annually, an amount that comes to nearly 60% of the national tab for such eldercare. In order to pocket a larger slice of the federal stipend, many nursing homes--largely for-profit enterprises--provide a minimal level of care, if that.
Packard and his investigators, referred to as "hearse chasers" by some in the nursing-home trade, have begun contacting relatives of deceased patients whose California death certificates cite malnutrition, dehydration and other signs of neglect. They're often shocked to learn what killed their loved ones. "They don't know their parents died of malnutrition," says Dina Rasor, an investigator working for Packard, "until we tell them." Even more telling, the causes of death on California death certificates are often listed by doctors affiliated with the nursing home involved, suggesting that Packard's list may well understate the number of deaths in which neglect played a role. Packard and his investigators are gathering death certificates for five more states, which they decline to name.
Death comes to the elderly in many ways, including heart and lung failure, chronic disease and plain bad luck. But David Hoffman, an assistant U.S. attorney in Philadelphia, thought he spied something else at work last year, when he saw festering bedsores eating away the flesh of three residents in a local nursing home. He knew the home had been pocketing government money the residents were given to ensure good care, and he saw the bedsores as proof that they weren't getting it. He investigated and later sued Geriatric and Medical Companies Inc., which operated the Tucker House nursing home. The nursing-home company settled the case for $600,000, sent condolences to the families of the three residents and--perhaps most important--set off probes by law firms around the country seeking similar evidence of poor care and the resulting fraud. Their plan: to present evidence of widespread fraud to the Justice Department in the hope that the government will take the lead in the case and share in any damages awarded.