Laura Jean Abeyta remembers her grandma always liked a new hairdo and fresh flowers.

But when she recalls Mary Abeyta's last month at the Santa Fe Care Center, what she thinks of are the soiled gowns, the wet clothes and bedding she or her father, Carlos Abeyta, would help change late at night.

"Those last days, it was not her," she said.

Carlos Abeyta said the odor still haunts him. "I hate that smell, it reminds me of it, of what happened," said the Santa Fe auto technician.

Mary Abeyta died in March 2008 at Christus St. Vincent Regional Medical Center at the age of 84. But the family claims the stitches in her forehead, pressure sores on her tailbone as well as dehydration, weight loss and malnutrition were the fault of the nursing home.

"It's difficult to put someone you love in a nursing home," said Laura Jean Abeyta, a St. Michael's grad who works as a juvenile probation officer in Española. "She was our gift, we trusted this place to take care of her."

Santa Fe Care Center is one of the best-rated nursing homes in the United States, according to U.S. News & World Report. But for the Abeytas, it serves as a reminder of the vigilance that is needed when a family member is a patient in one.

"We were not a family that dropped her off and said 'good luck,' " adds Laura Jean Abeyta. "We were there every day."

The family is one of two with pending lawsuits against nursing homes in Santa Fe operated by Texas-based Cathedral Rock. Another family has a lawsuit pending against Casa Real Care Center. The two are the only skilled nursing facilities in Santa Fe that accept Medicaid and Medicare patients.

Cathedral Rock recently entered agreements with the U.S. government in connection with an investigation into five nursing homes it operated in Missouri. The company leased the Missouri homes and no longer has business in that state, said Mike Evans, a company executive. But it does operate 10 facilities in New Mexico — and patients here will get more oversight because of the Missouri litigation, he said.

Evans said many of the problems in Missouri were from a previous operator, who was sentenced to jail in the spring of 2007 and barred from operating nursing homes. When Cathedral Rock affiliates began operating those homes in 2001, two were the subject of "consent decrees" and about to be closed by the state. Under Cathedral Rock's management, both of those facilities returned to compliance with the state and the consent decrees were lifted, Evans said.

He said Cathedral Rock cooperated with the investigation, accepted responsibility, and moved forward with a five-year oversight plan laid out in a legally binding "Corporate Integrity Agreement."

The agreement "sets standards of performance and oversight that if I were in the home, I would take great solace by this," said Evans. "It will be a positive in raising the care level." But, he noted, "We have 10 homes in New Mexico, we run three shifts, 365 days a year. It's pretty hard to run on zero defects."

Santa Fe Care Administrator Lynn White said the two homes in Santa Fe and another in Española are highly regarded and get good marks from the federal government's nursing home Web site. "The facilities we have demonstrate that we have great care. Two are above average, one is average. The company has provided anything I've requested for resident care," White said.

Eighty percent of the residents there are paid for by Medicare or Medicaid — which reimburses $4,500 to $7,000 a month depending on the patient. One patient has lived at Santa Fe Care Center since 1978.


Finding defects and trying to compare nursing homes is difficult even for trained investigators, said Dusti Harvey, whose Harvey Law Firm is handling the case against Santa Fe Care Center.

Different agencies inspect and rate homes. And mandated staffing depends on the number of patients at a given time of the day or night.

For instance, the recent rating at the medicare.gov site gives the 120-bed Santa Fe Care Center, 635 Harkle Road, four out of five stars for overall quality while Casa Real, 1650 Galisteo St., has three stars, up from two a few weeks ago. But under the staffing category, the 118-bed Casa Real now has 5 stars, while a few weeks ago the staffing information was not available, according to the Web site.

"Each facility is different, though they are within blocks of each other," said Peggy Winkler, director of clinical compliance for Cathedral Rock. She said the star ratings are a lagging indicator with the most recent inspection reports getting a higher weight.

White, the administrator at Santa Fe Care, said the rankings are comparative, so hers can change tomorrow based on other facilities, even if nothing changes at Santa Fe Care.


Both lawsuits against the Santa Fe facilities concern common complaints against nursing homes: staff levels, training and oversight.

State and federal requirements for staffing are complicated, said Amber Espinosa-Trujillo, the state health department manager who oversees inspections. The requirement for some nursing categories is one nurse for every eight patients during the day, but climbs to one nurse for every 13 patients at night.

When the health department does inspections, it doesn't just look at how staff is scheduled, but analyzes time cards and interviews patients, Espinosa-Trujillo said.

Evans, the Cathedral Rock executive, said the company spent $1 million on temporary agency nurses last year. "If we can't find a nurse, we go hire one. We don't find dollars by short-staffing our facilities. We don't do it, yet every home gets caught once in a while for the same reasons."

Those reasons are like those that other businesses deal with: People get sick or someone can't get in due to snow or a family emergency, Winkler said.


Inspection information on nursing homes also is not available to the public right away. Unlike restaurant inspection reports released by the state within days, nursing inspections are held back for 90 days, according to federal government guidelines.

For instance, state inspectors issued Casa Real an order the first week of February called an IJ, which means patients were in immediate jeopardy. The state worked with the facility to rectify the issue within days. But those shopping for a nursing home today won't find the information on any Web site or in the home itself until three months after it happened.

During the recent inspections at Casa Real, state health department staff stayed until 9 p.m. to make sure a plan was in place and patients were safe, Trujillo said.


When Carlos Abeyta first went to Santa Fe Care Center for a visit, it was a bright morning and the staff was attentive. The place was bustling with activity and there were songbirds in the lobby, he said.

But things are completely different at 10:30 p.m., he said, when call lights go off "like a Christmas tree" and the staff struggles to meet patient needs.

Carlos Abeyta said he expressed complaints about the care and was told his concerns would be addressed.

"I tell the family to go to the nursing home, go visit, go visit at different times of the day — go back at night," said Espinosa-Trujillo.

When Regional Ombudsman Gail Trotter goes into a nursing home to investigate resident complaints about their rights, "not everything has to be told," she said. "There are things you can see on your own." But a home with no complaints is not necessary good, she said, because, "People need to speak up."

"We see complaints as a good thing, not a bad thing," as that's how facilities get better. She added the state ombudsman has a right to get into a nursing home anytime of the day or night — and they use that authority.

She said hot line and help numbers are posted and she urges family and residents to "speak up, tell somebody what's going on."


The Santa Fe case pending against Casa Real was filed by the family of Tesuque resident Margarita Gonzales.

"This resident died as a result of the negligence, a mere three months after her admission to the nursing home. Numerous material medical records are now apparently missing or lost," Albuquerque attorney Neil Blake said in his court filing.

Blake would not elaborate. In its response, Cathedral Rock denies the allegation and attributes the death to an "unavoidable medical complication," "unforeseen conduct," "an Act of God," a "pre-existing condition" or "circumstances for which these defendants may not be held liable or accountable."

Evans said Cathedral Rock can't discuss the specifics of the Abeyta case or others pending in court. He said any trial will bring out "a number of issues positive to the facility."

Nursing home cases are emotional, he said, because the patients come for care when they are frail and sick. Many don't want to eat and their skin breaks down. "In any nursing home, part of that resident's later days are problematic," Evans said.

Harvey, the attorney handling the case against Santa Fe Care Center, said the nursing-home industry portrays the cases as a medical malpractice issue where plaintiffs should prove how someone died. She said it's about dignity.

"If this is your last sunset, your golden years, you have a right to die with dignity," Harvey said.


Dorothy McMurtry, the assistant U.S. attorney who handled the criminal case in Missouri against Cathedral Rock, said successful litigation against nursing homes is difficult. Her case took six years even with the cooperation of two employee whistleblowers who eventually received part of the money from the fines.

Patient witnesses are elderly and often sedated at the time abuse occurs and do not make good witnesses, she said. In the end, the amount collected was a fraction of the staff and legal time the government spent.

"It seems to be a pattern for nursing homes in particular," she said. There are many inter-related corporations and trying to determine who was responsible, who made the decisions, took us a long time.

"The money comes in, it's flushed in, it's flushed out, that is the pattern, it can be difficult for patients and families," McMurtry said.

McMurtry, Harvey and Trotter all emphasized the importance of family vigilance. "The best nursing home is the one closest to your home," said Harvey.

For the Abeyta family, even that didn't work.

"We looked at numerous options, and Santa Fe Care was the best," said son Carlos Abeyta. "The staff was there. During the day it's a model facility. Now we know it doesn't stay that way. That's what's scary ... knowing what I know now, I wish she had stayed home."

Contact Bruce Krasnow at 986-3034 or brucek@sfnewmexican.com.

ON THE WEB

• The government Web site for ratings of nursing homes which accept Medicaid and Medicare is www.medicare.gov. Under "Search Tools," click on "Compare Nursing Homes in Your Area."

• The National Consumer Voice for Quality Long-Term Care Web site is www.nccnhr.org.

• To read the state Department of Health inspection reports, go to www.nmhealth.org and click on the first item under "Important Links" at the bottom of the page, "Locating New Mexico's Licensed and/or Certified Health Care Providers."

• Attorney Dusti Harvey has helpful links on her Web site, www.newmexiconursinghomeadvocatenews.com.

• The state Aging and Long-Term Care Ombudsman's Office can be reached toll free at 1-866-451-2901 or online at www.nmaging.state.nm.us/Ombudsman_bureau.html.

HOW THEY RATE

Medicare.gov 5-star rating system for nursing homes:

Casa Real: 3 stars overall; 5 stars for staffing; 2 stars for quality measures

Santa Fe Care: 4 stars overall; staffing rate not available; 5 stars for quality measures