Many patients are at risk because one out of four nursing homes every year is cited for causing death or serious injury to a resident, according to government figures.
CBS News Correspondent Vince Gonzales reports on nursing home abuse.
Alice Oshatz is looking for an assisted living facility because at 85 she could no longer live alone, and she won't move in with her children. "I never thought this could possibly happen to me," she said. When she was asked if she's worried about becoming a burden, Oshatz began to cry.
"Yes, oh yes. That's the really hard part of it. My daughter lovingly she does it and everything, but I don't want her, if I'm going down, to pull her down," she added.
The family is agonizing over Oshatz's decision to move into an assisted-living home where she would still have a fairly independent lifestyle. But Oshatz is already thinking about the day when she may need a lot more care, and like half of elderly Americans she may have to move into a nursing home. That's an idea she dreads.
"I hope I go quietly into the far beyond," said Oshatz.
She is not the only one who feels that way. Eighty-three percent of elderly Americans would stay in their homes until the end if they could. Thirty percent say they'd rather die than go into a nursing home. And their fears may be well founded.
Nursing home inspection documents show that more than a quarter of American nursing homes were repeatedly cited for serious violations that caused death or injury to patients. In California, a third of the homes have been cited for causing serious harm or death to patients. In 1998, less than 2 percent of California nursing homes had no violations.
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A CBS News analysis of the federal government's nursing home inspection database finds more than 1,000 homes were cited last year for hiring staff with a history of abuse.
Federal regulators admit, however, that the statistics conceal how bad things really are inside America's nursing home. State inspections are often unreliable, and most problems in nursing homes go unreported. That's especially true when it comes to cases of physical abuse.
"Elder abuse is fast becoming one of the greatest law enforcement challenges of the next century," said Paul Hodge who investigates crimes against the elderly.
The Love family knows this all too well.
As a veteran of three wars, Donald Love was buried with full military honors at Arlington National Cemetery. But it was his ife, Helen, who was wounded in battle, at age 75.
Bruce Love found out his 75-year-old mother had been attacked by a nursing home staff member only after he called to check on her. But the home told him not to worry; everything was fine.
He said he was told "that there wasn't any problem, that she'd been examined by a doctor, and there weren't any major injuries."
And according to the nursing home doctor's report, "There was no head injury. No loss of consciousness....X-rays do not disclose any fracture of the mandible, forearm or wrist." The doctor said any bruising Love had was caused by her "medical illnesses."
Bruce's brother Gary reached his mother's side first. "I couldn't believe what I was seeing, bruises on her neck, on her chin," he said. "She had some bruises on her legs. I said, 'What the hell happened to you here?'"
He wanted to take his mother to a hospital emergency room a block or so away but the home refused to release her. Gary Love said it was only after he threatened to call police that administrators backed down.
"I couldn't touch her because they hadn't substantiated what her injuries were. This is in the hospital emergency room with my mother laying on a gurney, and I could not comfort her," said Bruce Love.
Emergency room doctors quickly discovered that despite what the nursing home said, Helen Love had a dislocated neck and a broken wrist. She was covered with bruises. Her condition was so grave doctors were afraid to operate on her neck. Instead they drilled holes in her skull and fitted her with a steel halo to hold her head up. It was a painful and draining treatment.
So what exactly happened to Helen Love?
On the night she was attacked, the 95-pound woman was bedridden in room 8B of the Valley Skilled Nursing Home in Sacramento, Calif. Around 7 p.m. on his eighth day on the job, certified nurse's assistant Tim Saelee entered Love's room and found that Love had soiled herself and needed cleaning. That upset Saelee, and he began handling her roughly. When she complained, Saelee attacked her, an eyewitness - and Love herself - told police.
"He got real ferocious and started beating me all around the bed," said Helen Love.
"He choked me and went and broke my neck...and broke my wrist," she said.
Love decided the only way she could survive was to play dead. Eventually Saelee left her room.
"I was going to fight...And I'm black and blue all over," said Helen Love.
When asked if she tried to fight back, she said, "Oh, I'm not a quitter; I'm a fighter.
But two days after she was interviewed on videotape, Helen Love died.
"I honestly feel that I let her down. I still feel that today. And that's what's so frustrating about this," said Bruce Love.
Also frustrating for the Love brothers is the sentence that the nurse's assistant received for attacking their mother.
"He did plead gulty to elder abuse, which got him a year in the county jail. You can go out on the street as an innocent person and have boxing match with somebody you don't like and get more time for simple assault or tax evasion!" said Bruce Love.
And this was not the first time Saelee was accused of abuse. He had been warned about rough handling of patients at another Sacramento nursing home. Then he was fired for threatening to hit a resident.
He was hired a month later at Valley Skilled. At this facility three other employees had convictions for abuse, which under state law should have prohibited them from working in a nursing home.
No one at the home would talk to CBS News on camera because the Love family is suing.
"I don't ever want to see another person ever have this done to them," said Bruce Love.
Company lawyers told CBS News that what happened was not the home's fault. It did everything the law required. But clearly in this case and across the nation, dangerous nursing home workers are not being detected, and elderly peopple certainly aren't being protected.
At least 33 states do some kind of background check on a very small number of nursing home workers but none require a national background check.
And a recent government report found state background checks aren't working, saying, "There was no assurance that individuals who may pose a risk to residents are systematically identified and barred from nursing home employment."
The California Department of Health Services told CBS News that it has revoked the license of one nurse assistant at the Valley Skilled Nursing Home.
Officials are also checking licenses of all nurses and nurse assistants at the home and are referring the case to the California Attorney General's Office.
Valley Skilled Nursing Home's parent company, North American Healthcare runs 17 facilities in California and applied to open three more homes in California but were turned down by the state in September 1999 because of "consistently poor care" in their facilities.