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Each year in the United States more and more families are forced to enter a family member into a nursing home because they are unstable to take care of themselves on a daily basis. There are approximately 2 million Americans living in nursing homes. Massachusetts has some of the lowest scores for nursing homes in the United States.

Almost 40% of Massachusetts 437 nursing homes received below-average scores during their most recent inspections due to a troubling catalog of lapses and abuses that are putting vulnerable seniors at serious risk, according to a recent Boston Herald review.

Massachusetts nursing home population is about 45,000. The Herald’s findings come at a time when the number of residents in such homes is expected to surge as baby boomers age into their 80s.

With so many boomers in the nursing home pipeline, advocates and families say they are extremely worried about the quality of care today and in the future.

“I think our system doesn’t require nursing homes to be good,” said Janet Wells, director of public policy at the National Citizens’ Coalition for Nursing Home Reform, who blames lack of oversight and low staffing for poor quality.

A Boston Herald examination of two years of inspection reports and complaint investigations for the worst-performing nursing homes in eastern Massachusetts bears out Wells’ concerns. The documents, provided by the Department of Public Health after months of public records requests, revealed dozens cases of poor staff training, unsanitary living conditions and overall neglect. For example:

At a Danvers home in 2008, nurses failed to perform CPR on a resident after finding her unresponsive. A doctor arrived 15 minutes later and pronounced her dead. The state investigated and faulted the home for providing poor care. In addition, a nurse said she falsified the dead woman’s medical records, the state found.

Residents are not always safe from their peers, as evidenced by the Sept. 24 murder of 100-year-old Dartmouth nursing home patient Elizabeth Barrow who was strangled in her bed. Her roommate, Laura Lundquist, 98, has been charged with murder.

A woman at a Lawrence nursing home informed investigators she was in “unbearable” pain for days because staff failed to reorder her pain medication on time.

Investigators caught a Lawrence nursing home resident smoking while using an oxygen tank. A resident was found flicking ashes on her bed sheets in a Chelsea home. In Danvers, a smoking room lacked a fire extinguisher.

In 2008 and 2009, there were 71 complaints of neglect and physical, sexual and verbal abuse of residents at 40 homes reviewed by the Herald. Of those complaints, 11 were deemed valid by the state. In 41 cases, the state couldn’t determine whether the abuse occurred. The rest were deemed invalid.

In many cases, staff failed to develop or follow through on plans required to protect residents from extreme weight loss, falls and leaving the home unattended, leading to serious injuries and health setbacks.

Below average

Overall, 38% of the state’s 437 nursing homes scored below the state average on recent inspection reports, according to state data. The average score is 121 out of 132 points.

Department of Public Health workers inspect nursing homes for state and federal violations on behalf of the U.S. Centers for Medicare and Medicaid Services. Surveyors review medical records, interview patients and staff, and tour the facility for several days. The inspections, done about once a year, are unannounced.

The information is used to compile a score for each of the state’s nursing homes.

In a joint interview, Bay State Elder Affairs Secretary Ann L. Hartstein and Mary McKenna, the Massachusetts ombudswoman for nursing homes, played down the state scores, which are available online at mass.gov. “We see it as one piece of data that people should use,” Hartstein said.

Neither would say whether they were concerned that 166 of the state’s homes scored below average. They also would not characterize a below-average score as good or bad.

“The average score is just the average score. People shouldn’t give it more weight than it has.” Hartstein said. “Just because (a home) is below the average score doesn’t necessarily mean they are not a good nursing home.”

Alice Bonner, director of the Bureau of Health Care Safety and Quality at DPH, said there are holes in the state system, but that it’s useful as one tool to evaluate nursing homes. The state and federal systems don’t measure staffing turnover, for example.

Not enough staff

There are no nurse-to-resident ratios mandated at Massachusetts nursing homes, although nursing home reform groups have pushed for them for years, said Wells, of the nursing home reform coalition.

Avoidable injuries and deaths at nursing homes in Massachusetts and other states can be traced to a lack of manpower, she said.

“Most nursing homes are too understaffed to avoid harming residents,” she said.

Some homes have replaced nurses with less-skilled and cheaper certified nursing assistants, said Charlene Harrington, a registered nurse and professor at the University of California at San Francisco.

The amount of time registered nurses spend with residents has shrunk by 25 percent, from 48 minutes per resident per day in 1998 to 36 minutes per resident per day in 2008, she said. A safe level is 45 minutes per resident per day, but higher for sicker patients, she said.

“If you don’t have that level it causes harm or jeopardy to residents,” Harrington said, citing malnutrition, infections and sores as frequent outcomes.

Susan Feeney of the Washington D.C.-based American Health Care Association, which advocates for 11,000 senior-care facilities, said nursing homes face a staff shortage. In addition, she said, Harrington’s numbers don’t reflect the efforts of therapists, nurse practitioners and physician assistants.

Back in 2008, we first reported that nine people were killed as a result of two crane accidents that occurred in New York in 2008. On March 8, 2010 prosecutors, announced that a crane-company owner was indicted on manslaughter and other charges stemming from the collapse of one of his 200-foot rigs that killed two workers in 2008, according to a recent Associated Press news report.

The indictment names James Lomma and two of his companies, New York Crane & Equipment Corp. and J.F. Lomma Inc. A former mechanic with New York Crane & Equipment also was indicted.

The top of the giant crane snapped and crashed onto a Manhattan apartment building in May 2008. It happened a little more than two months after another crane collapsed elsewhere in Manhattan and killed seven people.

District Attorney Cyrus R. Vance Jr. said the indictments were expected to end his office’s investigations into the crane collapses. Mr. Vance said the company wanted the crane repaired quickly to keep it generating income from construction contractors who rented the equipment.

“Failing to keep the crane operational would have cost the defendants about $50,000 a month in rental fees, a price the defendants must have felt was too much to pay,” he said. “Today, two families are paying a much greater price.”

City buildings officials approved putting the crane back in service with the repaired turntable, but authorities say the company misled inspectors about testing on the part.

 Toyota Motor Corp claims that vehicle safety and regaining trust from its customers are the company’s main goals as they continue to resolve issues behind the recent recalls of 8.5 million vehicles due to sticky gas pedals and floor mat interference, which can cause sudden acceleration, steering column problems and brake problems. On March 5, 2010, a House committee questioned how thoroughly Toyota has tested its vehicles for sudden acceleration, and asked the Japanese automaker for more records on the safety issues, according to a recent Associated Press news report.

The House Energy and Commerce Committee told Toyota executive Jim Lentz in a letter that there is “an absence of documents” to show whether the company thoroughly investigated the possibility of unintended acceleration. The committee demanded to know who is involved with the testing and receive quarterly reports detailing allegations of the unwanted acceleration.

“We do not understand the basis for Toyota’s repeated assertions that it is ‘confident’ there are no electronic defects contributing to incidents of sudden unintended acceleration,” wrote Chairman Henry Waxman, D-Calif., and Rep. Bart Stupak, D-Mich.

Adding to the doubts, the government has received more than 60 complaints from Toyota owners who had their vehicles fixed following the recalls but say they’ve had more problems with their vehicles surging forward unintentionally. Toyota dealers have been fixing the accelerator pedals but the National Highway Traffic Safety Administration said Thursday that if the remedy provided by Toyota is not addressing the issue, the government could order the company to provide a different solution.

Toyota hired a consulting firm to study whether electronic problems could cause unintended acceleration. The firm, Exponent Inc., released an interim report that has found no link between the two. But committee investigators have said the Exponent test was flawed because it studied only a small number of Toyota vehicles.

In the letter, Waxman and Stupak also request more details on brake override systems and “black box” information in Toyota vehicles.

Toyota plans to install brakes that can override the gas pedal in future models and many vehicles already on the road. The safety measure is meant to prevent the unintended acceleration that has caused some Toyota drivers to speed out of control.

The committee also wants to know what information is available in Toyota electronic data recorders. The “black box” information could help investigators learn more about what is happening in the vehicles before crashes. A review by the Associated Press found that Toyota has been inconsistent and sometimes even contradictory in revealing what the devices record and don’t record, such as critical data about whether brake or accelerator pedals were depressed at the time of a crash.

The NHTSA has linked 52 deaths to crashes allegedly caused by Toyota’s acceleration problems.