Inside the London House Care Center in Sonoma is a scene repeated around the country: old age, deteriorating health and people who need extra help getting around.
"No one says I want to go to a nursing home when I am older," says Louise Merrick, who runs London House and is a member of the California Association of Health Facilities. "Nursing homes of today I am sure people who haven't been in them for the last 5 or so years if you come in, for the very vast majority, they have greatly improved."
Forty-five percent of us will spend some time in a skilled nursing facility during our lifetime. And as the number of elderly people increases, nursing homes are preparing for admissions like never before.
"I am starting to see people come into my living center that are younger than I ... my age. It's not uncommon anymore and what they are bringing with them are things that I would bring as well, which are demands," says Merrick.
Nursing home advocates say things are far from perfect at many of the state's nearly 8,000 facilities.
"You can look at individual issues and say that's a lot better than it was 25 years ago. It's just that the problems are different," says Pat McGinnis.
For decades, McGinnis has been fighting for patient rights with the California Advocates for Nursing Home Reform. It successfully sued the state to demand consumer complaints be reviewed more quickly.
"What we find in many cases of many consumers is that their relatives were dead by the time licenses and certification to actually do an investigation," says McGinnis.
As a result of the lawsuit, the state now must start an investigation within 10 days of any complaint. The most severe are investigated within 24 hours.
"Since April of 2007, 99.3 percent of all of our complaints are initiated within 10 working days," says Kathleen Billingsley, R.N.
Billingsley is deputy director of the state Center for Healthcare Quality. She was hired two years ago to rebuild the ailing licensing and certification division that oversees nursing homes. Since Billingsley took over, more than 200 people have been hired.
"I believe that the program that we have allows us to protect the health and safety of the residents in nursing homes," says Billingsley.
Billingsley admits that while citations for violations are down, they are not gone.
Take the case of Berneda Campbell. When Monte Campbell put his mother in Pleasant View Convalescent in Cupertino, he hoped she'd live out her final days in comfort. Last year he got a call he hadn't expected.
"They found my mother dead on the floor of her room," says Campbell.
For 10 years, Berneda struggled with Alzheimer's and became immobile. A state investigation revealed an aide failed to operate a lift appropriately, dropping the 90-year-old on the floor and killing her. The state fined the home $100,000 dollars. Pleasant View is appealing the fine.
"There is a lot of money passing through those organizations and I can't imagine that $100,000 dollars is much of a deterrent in changing the behavior that took place that day," says Campbell.
UCSF nursing professor Charlene Harrington has been studying nursing homes since the early 1980's. Harrington says staffing shortages are often to blame in incidents like what happened to Berneda Campbell.
"We're going to continue to have poor quality until we bring the staffing up to minimum standards," says Harrington.
Harrington's research shows that while staffing is up three percent in recent years, the turnover rate has been just as high, mitigating any benefit.
"California only has about half of the RN staff that they have in other nursing homes around the country," says Harrington.
In 2004, California began giving nursing homes more money to increase staffing. But there's still a long way to go.
The state says it's working on it, but that change comes slowly, but things are definitely moving in the right direction.
If you're looking for a nursing home, use the links below to check up on the facility:
Written and produced by Ken Miguel.