And Piedmont Triad homes prove no exception.

Souza, who serves as executive director of the N.C. Health Care Facilities Association, said he warned lawmakers years ago that if homes did not get more state money to hire workers, quality of care would decline. His Raleigh-based trade group represents the majority of the state's nursing homes.

Nursing homes rely on federal and state governments for 85 percent of their revenue. About 74 percent comes from one program alone: Medicaid for the poor.

As a result, taxpayers hold great sway over the changing economics in the $1.2 billion nursing home industry. Last year, for example, 20 percent of the state's homes operated in bankruptcy, a byproduct of the federal government's 1997 decision to change the way it reimburses nursing homes. And the situation may grow worse.

Nursing home administrators say Medicaid already fails to cover the full cost of its patients' care. State lawmakers almost froze the amount of Medicaid money nursing homes receive at the current rate for the next two years. But after vigorous lobbying by nursing home operators and elder advocates, lawmakers agreed to a 3.5 percent increase to account for inflation in fiscal 2002. No increase is slated for fiscal 2003.

"It went up, but it didn't go up enough," said Lt. Gov. Beverly Perdue, who encouraged lawmakers to support the increase.

The trade group's Souza agrees.

"I've been in long-term care 24 years, and I've never seen it this bad," Souza said. "People think nursing homes don't provide quality of care now. Just you wait; quality will get worse."

But in some cases, such as Sutherland's, the care being provided was already of great concern.

Norma Jean Sutherland's family did not know what to expect when their matriarch needed a nursing home. And family members hadn't expected Sutherland to need one so soon.

She was just four years into early retirement when she lost her independence.

A native of the mountain town of Creston in Ashe County, Sutherland worked for almost three decades as a trust officer in Wachovia's Greensboro and Winston-Salem offices.

She favored stylish pocketbooks, fancy shoes and Cadillacs. Jewelry was a must, as was a dab of lipstick.

But on July 5, 2000, Sutherland suffered a series of strokes and was taken to Moses Cone Hospital, where she was treated and referred for rehabilitation in a nursing home.

Moses Cone gave Sutherland's daughter, Riley, the name of one nursing home, Carolina Commons at 308 W. Meadowview Road.

A new wing had been built. Crisp wallpaper borders hugged unscuffed, freshly painted walls.

Sutherland moved in July 18. After four weeks, Sutherland's private insurance ran out, and she returned home.

Two weeks later, Sutherland, who was then 59, suffered another stroke, and the family scrambled to find another nursing home.

Moses Cone gave Riley the names of two homes with beds available. Riley visited one and thought it looked like "an insane asylum from an Alfred Hitchcock horror movie."

The stench of human waste was unbearable. One resident started to vomit as she sat in her wheelchair in the hallway, but workers paid the woman no attention, Riley said.

The other home, Carolina Commons, was a familiar -- and welcome -- sight.

Riley moved Sutherland in.

But this stay would not go so smoothly as the first.

Because the strokes had paralyzed Sutherland's left side and weakened her right arm, she was dependent upon others for help with most tasks, from bathing to walking.

Riley, a former office manager, said she visited her mother daily on weekdays and twice each weekend day. She saw residents shouting for help -- sometimes for hours, she said.

One resident calling for help was a man with soup spilled throughout his beard and on his shirt, Riley said. He was thirsty. When Riley brought him a glass of water, he guzzled it -- and then drank two more.

Riley found pills in her mother's bed, suggesting the nursing aide did not watch to make sure Sutherland took her medicine. She had trouble swallowing because of her stroke. When Sutherland asked for help, employees told her to wait, Riley observed. Sometimes aides would not respond for more than an hour, Riley said.

Riley stopped taking out-of-town business trips, afraid to leave her mother alone for even one night.

She watched her once-stubborn mother retreat into herself, a change not uncommon among nursing homes residents, especially if neglect is involved, said Carol Teal, executive director of Friends of Residents in Long Term Care, an advocacy group in Raleigh.

"We all learn to cope with the reality that exists in an institution," Teal said.

Riley complained to the home's administrator, but she said little changed.

Carolina Commons, like much of the industry, was plagued by high worker turnover last year. During 2000, the home hired and lost at least five administrators and five directors of nursing, the position overseeing patient care, according to state records.

Carolina Commons has declined to discuss these issues. Dennis Tofano, Carolina Commons' administrator since September 2000, said he could not comment and referred questions to the home's corporate owner, Britthaven Inc. of Kinston.

Britthaven's vice president of marketing, Lori Jones, asked the News & Record to put its questions in writing, which it did. Jones later said the company would not respond to the five pages of questions.

Riley and Sutherland's experience is hardly unusual among North Carolinians.

Most of the complaints filed against North Carolina nursing homes last year alleged poor care and unprofessional service, and state records back up many of these claims.

Last year, the No. 1 violation among nursing homes was that they failed to ensure residents had a high standard of living, according to the state Division of Facility Services, which regulates nursing homes.

The state defines a high standard of living as one that respects residents' rights, privacy and preferences.

Thirty-six percent of homes provided services deemed to be unprofessional. This means employees did not follow appropriate procedure, such as using protocol set by the North Carolina Board of Nursing.

And Triad nursing homes are not faring much better than their counterparts statewide.

In High Point, state investigators issued 10 citations to Sunbridge Care & Rehabilitation for the Triad after a Sept. 27 inspection last year.

A community panel that makes regular visits to five High Point nursing homes submitted reports to the Area Agency on Aging about the conditions at the Sunbridge center two months later. Complaints ranged from bad odors in patients' rooms to not responding to a resident's call for help.

State investigators reported violations at Sunbridge ranging from verbal abuse and neglect of patients by staff members to allowing a patient to sexually abuse other patients.

Sunbridge fixed the problems, all of which occurred in the home's behavioral unit for patients with Alzheimer's and other mental illnesses, said Dan Hill, spokesman for Sun Healthcare Group, the home's corporate parent in Albuquerque, N.M.

Hill said the home anticipates investigators will visit it soon to conduct a new survey.

"We won't see the same problems we saw last time," Hill said. "And hopefully we won't see any problems."

At Brian Center Health & Rehabilitation in Eden in June 2000, state inspectors found 18 problems, five of which they considered a serious threat to residents' health. The home has been fined more than $168,000 since January 2000. Among other things, the home failed to prevent accidents and did not inform family members of a change in a resident's condition.

The home has not yet filed an appeal with the state.

Helen Myers, the home's administrator, said in a prepared statement: "We diligently strive every day to provide a safe and comfortable environment for our residents and staff. Nursing facility inspections are very thorough, and they cover numerous aspects of operating a facility. We take the results of our facility surveys very seriously and, when warranted, implement corrective action as appropriate."

Nursing home administrators say state reports can be misleading. Souza with the nursing home trade group says the enforcement system is subjective, relying heavily on hearsay.

Homes can also be penalized for relatively minor infractions, such as not giving each resident the same type of snack.

Still, many residents and family members remain unsatisfied with the level of care they are receiving.

Between Jan. 1 and June 30, the state received 1,018 complaints, 12 percent more than during the first half of 2000.

Part of the increase comes from heightened vigilance from residents and families, as well as increased expectations as to what constitutes appropriate care.

"We're Baby Boomers; we're used to shaking things up," said Sabrena Lea, a regional long-term care ombudsman with the state. Ombudsmen mediate disputes between families and nursing homes. Based in Greensboro, Lea, too, has watched the number of complaints grow.

Long-term care advocates aren't the only ones receiving more complaints. Raleigh attorney Stephen Gugenheim specializes in lawsuits alleging nursing home neglect. His case load is growing. Fast.

"I think we will see more and more verdicts against nursing homes," said Gugenheim, who is involved in two lawsuits against Carolina Commons.

People should not expect perfection, said Wendy Sause, a one-time nursing aide and former long-term care ombudsman with the state.

But nursing homes are a business, she said, and they must be held accountable for the services they provide.

"Sometimes there tends to be the excuse of 'I'm sorry your mom didn't get taken to the bathroom and had to sit in urine and had her skin break down, but we just didn't have the staff,'" Sause said.

"If they have problems, they need to fix them," she said. "We wouldn't accept a baby-seat manufacturer saying they didn't have enough staff, ... and that's why your baby fell out onto the floor."

Sutherland's daughter, Riley, has considered filing a lawsuit against Carolina Commons, but watching her mother's health deteriorate exhausted her physically and mentally.

Riley's family has been emotionally drained, too. Riley's husband, Rex, who works in the production department with the News & Record, took on more household chores, such as washing the family's laundry. The Rileys had less time for their young daughter and son. And they felt guilty for time spent at their Greensboro home instead of at Carolina Commons.

By March, Riley had had enough. She filed seven complaints with the state against Carolina Commons.

Later that month, state investigators spent three days at the 210-bed home, one of Guilford County's largest. Their report cited 28 deficiencies, or violations.

The state agreed with four of Riley's complaints. According to the state's records, Carolina Commons' staff failed to provide timely incontinence care, to administer medications properly, to provide bathing/hygiene as scheduled and to follow doctor's orders for Sutherland.

Carolina Commons, which has been fined $58,000 because of deficiencies found at the home, is appealing the findings from the March investigation.

Nursing homes are required to submit a written plan of correction to the state when serious problems are found. According to Carolina Commons' plan, the home said it would train employees on "dignity issues."

"The facility will continue to promote care for the residents in a manner and environment that maintains or enhances each residents' dignity and respect in full recognition of his/her individuality," the plan states.

In late July, investigators returned to Carolina Commons and found more problems, ones that the state felt constituted "immediate jeopardy to resident's health and safety."

Among the findings: Female residents were not protected from sexual advances by an aggressive male resident, and nursing aides did not receive required annual training.

The home has not yet appealed the latest findings with the state, according to the Division of Facility Services.

In April, Riley thought her prayers had been answered. A bed was open at another nursing home, Guilford Health Care Center at 2041 Willow Road in Greensboro.

Riley moved her mother. Shortly after, Sutherland tried to get out of bed unassisted, but she fell forward, nursing aides told Riley. A worker found Sutherland lying in a pool of blood, Riley said.

Sutherland was taken to Moses Cone, where she lapsed into a coma and died -- less than 36 hours after leaving Carolina Commons.

Doctors told Riley the force of the fall had broken her mother's chin and shattered her dentures.

Riley does not fault Guilford Health Care because she feels employees tried to be responsive to her mother's needs.

But she still worries, even though she no longer has a loved one in a nursing home.

"They broke her spirit. They destroyed her dignity," Riley said of her mother's treatment at Carolina Commons. "I moved her (to a new home) in the hopes of trying to rebuild, but I never got a chance."

Contact Kerry Hall at 373-7061 or khall@news-record.com

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