Here are some articles about Ila Swan:

The article below article appeared in the Medical Journal in Australia.

Dear member,

Ila Swan is a very remarkable lady. An ordinary (really extra-ordinary) member of the US community with no medical knowledge. She discovered what was happening through her own experiences, became intensely involved and put her heart and mind into doing something about it. She marched, she carried placards, she went out and gathered information herself - thousands of death certificates - photographs - hidden video cameras. She went to political hearings, interrupted and aggressively challenged politicians with the funding they received from nursing homes and the protection which they gave the industry. She commenced a Qui Tam action on behalf of the government. The information she provided was sufficient to convince influential people. Several GAO investigations and federal senate hearings followed.

Citizens in states across the USA took up the challenge and forced investigations and hearings. The revelations and much of the material I have supplied you about nursing homes are a consequence one way or another of her efforts. She was a motivating force behind the recent CBC news investigation and the focus of one of the segments. She has appeared on Japanese television explaining what happens in a for profit system and urging the Japanese people to reject it. She wants a citizens movement to force the United Nations to confront the stark facts of US corporate nursing homes and address it as an international human rights issue.

It is people like this, not government regulators who expose what is happening and take action. There is a vast pool of motivation and human concern to be tapped. The community nursing home where Mrs. Bishop's father is a resident is an illustration of the contribution which the community can make and an illustration of how much more effective they are than any formal government backed oversight or accreditation process. We ignore the human potential and humanity of our citizens at our peril. If we are to provide a caring service for those in need then they must be intimately involved, honest, trusting, cooperating, assisting, criticizing, monitoring, suggesting, even being difficult and disruptive.

This is simply not possible in a competitive market system where successful detection of problems and their containment is dependent on every one involved, patients, relatives and regulators being distrustful and suspicious - shopping around. In the market the disclosure of failures is a threat to economic survival and every effort is made to hide deficiencies. How can we build or maintain a society in this way? We are a community of human beings and not an impersonal marketplace driven by market principles and competition. The logic of deliberately driving a system with severely disruptive competitive pressures and then expecting to stop the problems by regulation and policing escapes me. In such a system unintended and undesirable side effects and outcomes are inevitable.

I include the text of a letter written to the Calgary Sun by Ila warning Canadians not to adopt the US system. The Sun, once a supporter of health care reform, has done its homework and is now critical of government conduct. The letter is "pure Ila" in expression. It may be difficult for an editor to publish because of its length. It would not be published in any Australian newspaper until it had been edited to extinction. It reflects the kindness, concern and humanity of the American people. Those of you who have travelled in that country will have experienced the warmth, responsiveness and kindness of the people - the willingness to be helpful, the smiling "you're welcome" to any word of thanks.

You will also be aware of their pride in America, its history and its way of life - their sense of who they are. What is happening in that country today is a profound challenge to "self" - the sort of people they really are - a very disturbing experience. Ila's letter reflects the anguish of identity in the community as it is faced with this problem - a challenge to their sense of being a "decent" people - a challenge to their strongly held historical views of the benefit of the marketplace and its role in democracy. They are finding that this great free country selling democracy to the world is no longer a democracy. It is governed by large dishonest groups with money - the buying of politicians, the control of peoples minds by marketing and buying advertising. The market has become a threat to democracy.

It is a great credit to Americans that instead of closing ranks, ordinary citizens rather than leaders have been open and self critical. I have never had to explain what I was concerned about. They have known immediately and with few exceptions have supplied me with information and assistance knowing that I would use it to attack the US health system and this would reflect on their country. They have been more concerned for our welfare and the threat which their system poses for us. These, not the multinationals are the real "global citizens" - our hope for a human world.

US people are better equipped than any other to lead the way into a shared global society. They are open, honest and very willing. At the grass roots level they are ideal global citizens. However until they reform government and harness their corporate system to the will of the people they remain a threat to the rest of the world. With their wealth and technology, and this wonderful resource of human feeling they are in a better position to lead in developing participatory democracy and then a global community than anyone else.

Ila never loses an opportunity to spread her message. I am sure that she will not mind my sharing her letter with you.

Ila's important message to Canadians is in her last paragraph. It is expressed in her usual style.

"I will tell you, like I told Japan, DO NOT ALLOW US NURSING HOMES IN YOUR COUNTRY. Do not allow your wonderful non-profit system to be taken over by for profit hospitals and health care industries. The US is a sorry example of what happens when money is involved with your health care. The minute these for-profit companies move in, they start shoving money into your governments pockets, then they become obligated to this killer industry and your citizens will be the ones that suffer. If for profit health care is allowed in your country, it will be a terrible injustice for your citizens."

This is the message from someone who has walked through hundreds of nursing homes documenting what happens. She has looked more closely at the US for profit aged care system than anyone else in the world. We should listen.

No-frills crusader attacks nursing home abuses

The Sacramento Bee
By Mareva Brown Bee Staff Writer (Published Jan. 5, 1999)

VACAVILLE -- Ila Swan's passion was born in a tiny room at a Vacaville nursing home, where she went almost daily for nearly two years to feed her fragile mother.

One January day in 1993, a sobbing patient told Swan that her 88-year-old roommate, who was supposed to be under 24-hour watch after suffering a stroke, had fallen from her bed in the middle of the night, cracking open her skull. The woman lay bleeding for 20 minutes before nursing staff discovered her, the roommate told Swan, and died the next day.

Outraged, Swan looked up the woman's death certificate to see if the coroner had found the nursing home negligent. As she thumbed through hundreds of records in Solano County, she recognized the names of other former patients at the facility. She was horrified to see how they had died. "Dehydration, malnutrition, sepsis from bedsores," said Swan. "That's murder."

The woman's death and Swan's subsequent concerns about the care her mother received at the facility spawned a mission that has consumed all of her spare time and most of her disability pension. At 58, Swan has become one of the nation's most formidable crusaders against nursing home abuses. Her work, which includes files on more than 26,000 deaths in nursing homes, has provided the foundation for two federal probes and a state reform effort.

"We are grateful," said Jill Gerber, spokeswoman for the U.S.Senate's Special Committee on Aging, which ordered the U.S. General Accounting Office to investigate nursing home care after seeing Swan's files.

The GAO report, released last August in conjunction with federal hearings, criticized the California Department of Health Services for "systemic" enforcement weaknesses and recommended stronger federal oversight of state monitoring efforts.

Industry representatives have downplayed the report, saying its assessment of the risk to patients is overblown, the product of flawed methodology. State officials say the high volume of citations issued to California nursing homes -- cited by the GAO as an indication of a troubled system -- is actually a testament to the state's aggressive regulation and enforcement efforts.

But the report echoed Swan's condemnation of the nursing home industry and the ineffectiveness of the state agency charged with monitoring care. "Nursing homes have hurt a lot of people," she said with characteristic bluntness. "Their families remember. And there are a lot of people out there who would like to see something done."

Many credit Swan -- a plain spoken, no-frills, former telephone company worker, who used a wheelchair for years after falling from a telephone truck -- with breaking through a vast and seemingly uncaring bureaucracy to force change.

"Ila is one of my heroes," said Dina Razor, a noted independent investigator in the Bay Area whose work on military fraud helped launch probes into Pentagon spending. More recently, she began looking into nursing home fraud and said Swan's files gave her the ammunition she needed to force federal action.

"She doesn't care what people say about her," Razor said. "She's not interested in a position of power; she's not impressed by rubbing elbows with the influential. And she doesn't care who gets the credit -- as long as things change."

Swan also has her detractors. "I've never met the lady, but among all the self-appointed activists, she's probably the most extreme and least credible of all of them," said Gary Macomber, executive vice president of the California Association of Health Facilities, which represents nursing homes. Among his complaints is Swan's assumption that a patient who dies of dehydration necessarily has been neglected. Some, he said, refuse to eat or drink.

Brenda Klutz, deputy director of the state Department of Human Services, another target of Swan's criticisms, said only, "It's very obvious she has some deeply held beliefs that she's advocating for."

Nobody disputes that Swan resorts to frank language to get her point across.

This fall, in opposition to Dan Lungren's bid for governor, she hitched a small billboard behind her pickup and drove throughout the state. On it were photos of Lungren's face, a giant bedsore and the accusation that as state attorney general, Lungren had failed to prosecute nursing homes for criminal negligence.

Lungren spokesman Matt Ross said the attorney general's office has chosen to prosecute the employees responsible for harm at a given facility, rather than their employers and companies. At the beginning of December, he said, the attorney general's elder abuse unit was investigating 209 cases.

The billboard was enough to keep Swan from being included on a statewide task force of some 50 advocates, industry representatives and state regulators who were convened in October to review the GAO's criticisms."We didn't want an adversarial tone to our meeting; we wanted a dialogue," said Tom Porter, state representative for the American Association of Retired Persons.

Swan went to the meeting anyway, conducted herself "professionally," according to Porter, and was invited to participate in the final two meetings.

While she is satisfied to be included in the process, no amount of reform will erase the memories of her own mother's suffering.

Swan's mother, Rhoda Johnson, transferred to Creekside Care Convalescent Hospital, near Swan's home in Vacaville, on Nov. 21, 1991, from a Utah facility. When she was admitted, Johnson was able to take a couple of steps with a walker, talk coherently and use the restroom if someone helped her, according to Swan. But at Creekside, Swan maintained in a subsequent lawsuit, she went downhill quickly.

In early 1993, Swan filed a complaint with the state Department of Health Services, alleging she walked into her mother's room and found her tied to the bed in four-point restraints, naked, with an open window blowing winter air across her body.

State regulators, unable to substantiate the claim, did not issue a citation in response to that complaint. They did, however, issue one in response to a letter Swan got from Creekside's attorney, threatening to evict her mother if she complained to the state again.

By the time Johnson left Creekside in July 1993, her left leg was so contracted doctors cut the tendons to straighten it. She was covered with bedsores, unable to walk or talk. Swan maintains in the lawsuit that Creekside was so understaffed that aides could not provide minimal care.

Ultimately, Swan transferred her mother back to the Utah facility. Within three months of her return, Johnson was again coherent and her skin clear, although she never walked again. She lived until March 1998.

Creekside's new attorney, David I. Brown, defended the facility, saying even patients who are well cared for can develop bedsores and other problems. But he acknowledged that the facility's response to Swan's complaints "didn't foster good communication," and said that's why he settled her lawsuit for $775,000.

The experience fueled Swan's anger over the January 1993 death of the woman who fell from her bed. She expanded her search of death certificates, eventually combing the files of all 58 California counties and spending thousands of dollars of her own money.

She peppered the desks of politicians in Sacramento and Washington with strongly written letters that detailed alleged abuses and urged an overhaul of the Department of Health Services. And she called the relatives of patients whose death certificates she'd collected, urging them to sue. But it wasn't until Razor came across Swan's work that Swan's cause began to gather momentum. Razor persuaded the U.S. Senate contacts she had made during her Pentagon investigation to take a look and ultimately to hold hearings on the issue.

Today, Swan's phone rings off the hook -- patients' families, patient advocates, state regulators responding to complaints she's filed on behalf of others. Weekly, she visits nursing homes. If she doesn't have a client to see, she heads for the nearest alert patient, introduces herself and asks about his or her family. "While I'm talking, I'm looking and smelling," she said. "I act like I'm straightening their skirt and I'm checking for bruising. I test the back of their hands for dehydration."

Some frown on that hands-on advocacy. But Swan doesn't care. "Ila's got nothing to lose," said Lesley Ann Clement, her attorney. "Because she's seen the horrors. She's lived it. And she doesn't want it to happen anymore."

Copyright © The Sacramento Bee ********************************************

Legislators look at nursing home reform

From: Daily Republic Online drnews@dailyrepublic.com Jan. 20, 1999 By Catherine Moy DAILY REPUBLIC

SACRAMENTO - Six months after a federal report showed that one-third of California's nursing homes cause death or serious harm to their patients, state legislators began searching for ways to stop the problems.

State senators and Assembly members met on Tuesday during a joint hearing titled the "Quality of Care in California Nursing homes." The legislators made no new laws, but promised to follow through on what everybody agreed is a serious problem: abuse and neglect in nursing homes. But not everyone agreed on the extent of the problem or how to stop it.

"In 63 percent of nursing homes, people . . . are receiving inadequate care" said Assemblywoman Elaine Alquist, D-Silicon Valley. "I do know we need a basic restructure."

How to do that was a big topic of discussion, which ranged from staffing at nursing facilities (too low, according to most), to enforcement (lax and inconsistent, according to reports and advocates), to how to fund the 1,400 nursing homes in the state (the state now pays more than $4 billion annually on the facilities).

The four-hour hearing - which followed three months of study and discussion by stakeholders in nursing home reform - produced a multitude of ideas, though it was never clear what the ultimate outcome would be.

Several lawmakers seemed eager to craft bills to strengthen enforcement with tougher fines, while increasing pay for certified nursing assistants, who do the bulk of the patient care at large skilled nursing facilities.

Most witnesses disagreed politely - until the end of the session when the public was allowed to speak. In less than 20 minutes, the public speakers raised more issues and reasons that had not been touched on in the previous four hours.

Vacaville resident Ila Swan, who became a national advocate after her mother developed bone-deep bedsores in a Vacaville nursing home, stood up and told the legislators her theory on the problems. It comes down to two words: Political contributions.

Swan knows a bit about the nursing home industry. She received national attention after finding hundreds of death certificates showing patients dying in nursing homes of starvation, dehydration and bedsores.

The General Accounting Office took notice, investigated and found the poor conditions in California nursing homes. In July, the Senate held subcommittee hearings in Washington based on Swan's work. Swan on Tuesday told the legislators that most of them had taken money from the nursing home industry and that, in effect, is why the system allows neglect and abuse of the elderly. It is why there hasn't been meaningful reform in years, Swan said.

Swan's remarks put state Sen. John Vasconcellos, D-San Jose, on the edge of his seat. He denied that political contributions sway his vote. Swan persisted, asking him whether he took money from the nursing home industry. He answered by cursing loudly.

Next up was a terminally ill woman who has worked most of her life in nursing homes. She began by admitting that she is a nursing aide who doesn't do her job very well. "I resent giving poor quality of care", said Leatta McMurry of FairOaks. But she does so because she has no choice. Sometimes she's responsible for 20 or more patients. She can't bathe them, feed them, give them their medications and keep their bedding clean.

Overworked and underpaid employees are a big problem, several speakers testified.

A University of California, San Francisco, study backed up this problem. "There was simply not enough staff and not enough people to give them food or water" said Charlene Harrington, Ph.D, and a registered nurse working with the UCSF school of nursing who talked about the report.

``It doesn't matter how much they want to do their jobs, they can't."

Enforcement is lax and nursing homes don't always have to pay their fines for their poor care, said Pat McGinnis, executive director of California Advocates for Nursing Home Reform. When they do, the fines are relatively small compared to their profits. "If you āre going to fine a facility for killing your mother, let's make it meaningful" McGinnis said.

The state should reward good nursing homes, making them an example to follow, said Mel Matsumoto, past chairman of the California Association of Home and Services for the Aging. "Reward us for excellence" he said.

The legislators promised to take the ideas and work for reform. "Everybody knows what needs to be done, let's just see what they do" Swan said. ************************************************* http://www.dailyrepublic.com/

News: "Attorney general, activist tackle elder abuse" By Catherine Moy

VACAVILLE - Ila Swan is prepping her trailer of death for a road trip.

The billboard trailer used to have a big picture of former Attorney General Dan Lungren on it posted next to a victim of Auschwitz death camps and another similar-looking victim, an elderly man brutalized inside a California nursing home.

She's looking to redecorate. "Oh, yes. I'm looking for a picture of (state Attorney General Bill) Lockyer - and (Gov.) Gray Davis, too," the Vacaville resident said, adding she'll take the trailer on highways and byways to alert people about nursing home abuse.

The pictures may change, but the message hasn't: Politicians such as Davis and Lockyer take money from nursing home lobbyists and fail to protect the elderly inside nursing homes, Swan said.

And come Tuesday, Swan will face Lockyer and other state officials at a Vacaville conference and ask them why. Why don't they stop the horror inside the facilities?

"I have a question for Lockyer," Swan said. "The Texas AG in one year prosecuted 100 nursing homes. What's the problem here?"

Lockyer has prosecuted one nursing home for the crimes since he took office in January 1999. He has also dedicated 20 new investigators and prosecutors to pursue elder abuse cases, in addition to launching a new operation to do surprise visits at nursing homes, said Sandra Michioku, AG spokeswoman.

"I think that he's aggressively pursuing protection of elders," Michioku said.

The Napa-Solano Area Agency on Aging is hosting an elder abuse prevention conference Tuesday and Wednesday at the Ulatis Community Center where Lockyer will speak. Participants hope to find some answers to help prevent elder abuse, inside and outside nursing homes.

"The Area Agency on Aging, along with the other organizations active in the fight against elder abuse, believe that it is extremely important to raise public awareness of elder abuse . . . ," said Robin Crown, executive director of the AAA, in a prepared statement. "This conference will further that goal . . ."

Swan hopes so, but she isn't confident that they will commit to changes. "They've got to look at campaign financing," Swan said. "There are three things that will stop these deaths: stop money to politicians, put in an oversight system and make them accountable . . . and then you have to hold them criminally accountable. If they kill somebody they go to jail, just like you and me."

The conference comes two years after the Solano County Board of Supervisors took steps to stop the abuse. They created a special office that focuses on family violence, including elder abuse. They created a committee, the Elder Abuse Prevention Council, to work on the problem.

Since then, the number of complaints and state citations in Solano County's skilled nursing facilities have decreased. In 1995, the state issued 22 citations for problems inside the county's facilities. Only one citation was issued in 1999, according to an analysis of state records by the Daily Republic.

Those numbers don't mean there is less abuse in nursing homes, it means oversight isn't working, Swan said. Just last week, the state decided it would cite a Vallejo nursing home for scalding an elderly man in the shower, sending him to the emergency room with severe burns. Swan turned the case over to the state.

Report after report emphasized the danger in the facilities.

A congressional report released this month found that one-third of the Bay Area's 288 nursing homes between September 1997 and January 2000 hurt patients or put them at risk of death of serious injury.

Solano and Napa counties' record was even worse. More than half, or 17 of 29 homes, were cited for putting patients at risk of injury.

In November 1999, Rep. Henry Waxman, D-Los Angeles, asked for an investigation into nursing home abuse in LA County. That report showed that one in five facilities posed serious risks to patients.

And in 1997, Sen. Chuck Grassley, R-Iowa, called for a congressional investigation into California's nursing homes after Swan sent him death certificates from Solano County and throughout the state showing patients were starving to death and dying of thirst inside the homes.

That report, released during congressional hearings in Washington, showed one-third of California's nursing homes were causing serious harm or death to patients. Yet the consequences for such poor care are almost nonexistent, Swan said.

On May 10, Lockyer issued a press release announcing that he was bringing "the first ever enforcement action against (a) nursing home for alleged elder abuse and fraud."

A year and a half after taking office, Lockyer filed that criminal complaint against two Los Angeles nursing homes and their owners and operators. He alleged that a nursing home operator stole more than $40,000 from a World War II Nazi concentration camp survivor.

Lockyer agrees that more needs to be done to stop elder abuse and he made changes toward that goal.

"When he took office, he noticed that the Bureau of MediCal Fraud needed more resources,'' Michioku said.

"One of the difficulties is that when you need to beef up your enforcement unit, it doesn't happen overnight."

The attorney general also changed the name of the MediCal fraud unit to the Bureau of MediCal Fraud and Elder Abuse, she said.

Elder abuse is largely a hidden epidemic, Crown said.

"Elder abuse affects hundred of thousands of elders across the country," he said in the press release. "However, because so much is hidden under the shroud of family secrecy or behind the doors of substandard facilities, elder abuse is grossly underreported."

Organizers of the conference hope that will change through public awareness and tough enforcement.

Swan prays for the abuse to stop and hopes people will act, not just talk.

"Do we have to stack the bodies head to foot all the way to Washington to get somebody's attention?" Swan said.

For more information on the conference, call 644-6612. Catherine Moy can be reached at cmoy@dailyrepublic.net.

*****************************************************************

www.sfgate.com " NURSING A GRUDGE ABOUT ELDER CARE"

Ila Swan of Vacaville crusades on behalf of institutionalized seniors Sam McManis, CHRONICLE STAFF WRITER Friday, July 23, 1999 ©1999 San Francisco Chronicle

She is not wearing one of the 19 wigs or sunglasses she uses to conceal her identity. No need, this time Ila Swan has not come to the Vacaville Convalescent and Rehabilitation Center on another reconnaissance mission in her work to expose what she says is widespread neglect and abuse in nursing homes.

Swan is just here to visit Frances Jehle, her mother's former roommate. Maybe they would read a large print copy of Reader's Digest and share a smoke on the patio. But, as she flings open the double doors and makes a sharp left at the potted plant, she cannot help herself. Swan, arguably the nation's most outspoken and influential advocate for nursing-home reform, already has segued into full activist mode.

She notices a call light on above the door jamb to Room 8. State health service codes state that patients ``show evidence of good personal hygiene'' and that staff must respond as soon as possible after being summoned. She notes the time, 1:02 p.m.

In front of Room 42, she suddenly stops and pokes her head inside.

``Smell that?'' she asks. ``It's overpowering. This man must be sitting in his own waste.''

Swan bends to the man's wheelchair, takes both of his hands in hers to inspect his nails for cleanliness (dried food is caked on his cuticles), removes his slippers to check for bedsores (none). His head remains lowered. She questions him about himself, his family, then asks how he likes living at the facility. Slowly, the man raised his head to meet her eyes.

``Why would I like it here?'' he says.

As she leaves to find Frances, Swan notes that the call light still is on at Room 8. It is 1:22 p.m. -- -- --

Swan is neither a doctor nor a state health official. She is a 59-year-old retired telephone company worker from Vacaville who serves as West Coast advocate for the nonprofit Association for the Protection of the Elderly.

Six years ago, Swan pulled her mother, Rhoda Johnson, out of this facility -- then called Creekside Care Convalescent Hospital -- after alleging widespread patient neglect that would later result in more than a dozen lawsuits by families of residents. Swan settled her suit in 1996 for $775,000, the largest nonpunitive award ever given in the state.

Swan's subsequent digging, which includes files on 26,000 deaths in nursing homes and voluminous eyewitness accounts and photographs of what Swan calls ``fatal neglect'' by the industry, prompted two federal investigations. Last summer, the U.S. General Accounting Office's report on California's 1,400 nursing homes concluded that, between 1995 and 1998, 30 percent of the homes were cited for causing death or serious harm to patients. Just 2 percent were found to have minimal or no deficiencies, according to the report.

``Ila Swan is an ally of nursing home residents everywhere,'' says Sen. Chuck Grassley, R-Iowa, chairman of the Senate Special Committee on Aging. ``Her contributions have been valuable to our committee as we work to improve the quality of care in nursing homes nationwide.''

On this day, Swan is in the trenches. She finds Frances Jehle sitting alone in her wheelchair in a lounge, staring out the window. Jehle is 80, suffers from diabetes and has a pacemaker. But her eyes light up when Swan bends to greet her and, surreptitiously, inspect her body. Swan asks Jehle about her daughter, Wendy, while performing a skin pinch test that appears to indicate Jehle is dehydrated.

``Let's take a walk, OK, Frances?'' Swan says.

Swan rolls Jehle toward Room 8, where the call light remains lit.

``It's 1:40 p.m.,'' Swan says. ``That'll go in my next report (to the state).''

Swan leaves the home, heads to her pickup truck to write down notes on the visit.

-- -- --

Sacramento attorney David I. Brown, who has represented the Vacaville facility in litigation, groans when a reporter mentions Ila Swan.

``Oh yes, her,'' Brown says.

Brown calls Swan an extremist. He says he's been to the Vacaville facility many times and ``it's beautiful, well maintained. I'd put my 80-year-old father in there if he needed it. If it's such a bad facility, why does Ila Swan still let her friend stay there?''

Jehle's daughter, Wendy Peet, has sued the home, charging negligence. Peet claims that a bedsore on Jehle's foot later required her left leg to be amputated.

Neither Michael T. Kelly, owner of the Vacaville Convalescent and Rehabilitation Center, nor Tim Aust, its chief administrator, returned numerous phone calls. But Brown says Swan targets facilities -- such as the Vacaville center -- for minor violations, if any even exist.

``It's a grudge thing with her,'' Brown says. ``She oversteps her bounds. There's a thin line between activism and zealotry. Maybe Ila's problem falls in the definition of mistreatment. . . . Maybe it's just a staffing problem. We'd like to think all of these places should be heaven on earth, but all (residents) can't have minute-by-minute, all-the-clock care unless the state is going to spend $100,000 a year per patient.''

-- -- --

At 59, Swan could be living a quiet life at home with Bob, her husband of 43 years. They both have pensions. Their Vacaville home is paid for. Their kids are grown, the nest empty. Well, not totally. Swan's two pet macaws in the living room squawk at ear-splitting levels.

But Swan has chosen a different life. Even her noisy birds are often drowned out by kitchen clatter: the constantly ringing telephone, the humming fax machine, the VCR churning out another copy of one of Swan's graphic nursing-home abuse videos to send to politicians and media outlets.

Some folks put family photos in laminated albums; Swan has crammed 21 books with explicit photos of nursing home abuse -- ranging from maggots swarming in bedsores to massive bruising to starvation -- and has yellow-highlighted transcripts from the 80 lawsuits in which she has participated.

``If I could walk away, I'd do it in a minute,'' she says. ``Who'd want to spend days and nights walking through these stinking facilities? But I don't want to be like the citizens of Germany living outside the concentration camp gates saying they didn't know about the Holocaust. These dirt bags who make money off the pain of the elderly, I just want to go and kick their asses. I don't want to close down the nursing homes. I just want decent people running them.''

Gary Macomber, executive vice president of the California Association of Health Facilities, which represents nursing homes, defends care provided by California facilities.

``Workers are human,'' he says. ``They make mistakes. Studies have shown that the bulk of elder abuse goes on in people's homes, not in nursing facilities.''

-- -- --

Ask Swan why she spends thousands of hours and dollars on lobbying for reform and she'll relate the details of her mother's horrific case with almost clinical detachment.

``In '91, I first took mama to Creekside,'' she says, sipping iced tea in the kitchen. ``I expected her to get cared for. Just like with a baby: Feed the top, clean the bottom, make sure they get nutritional meals and exercise.''

Swan says she visited her mom every day but failed to notice signs of neglect. In a few months, her mother lost the ability to walk, to go to the bathroom on her own, to maintain her weight. She even stopped talking.

``I finally asked the doctor and was told she was on 17 medications,'' Swan said.

Swan saw many indications of other residents being neglected. An accident that cause the death of one of the residents sent her to the Office of Vital Records to find the listed cause of death. Another resident said her room mate had tried to climb out of bed. She tried to get out of bed, flipped over and hit her head and died.''

Shaken by the incident, Swan looked up Mildred's death certificate at Solano County offices. What she found flipping through hundreds of death certificates of elderly who lived at nursing homes astounded her.

``When I read a certificate in which the elderly person died at home, the cause of death was always aneurysms, coronary infarctions, cancer -- things you'd expect,'' Swan says. ``I got to where I could tell who died in a nursing home without looking at the address. The cause of death would always be something like dehydration, sepsis (blood poisoning from bedsore infection), malnutrition, senile dementia, urinary-tract infection.

``By the time I found Mildred's certificate, I already found 15 others. I'm saying to myself, `What in the world is going on here?' ''

Swan went from curious citizen to incredulous crusader. She had never been much of a rabble-rouser before. She was a woman of simple tastes, spending time watching movies, doing ceramics, going to lunch with her three grown children.

``I got caught up in the injustice,'' she says. ``What would you do?''

What Swan did was make copies of more than 100 nursing-home death certificates in Solano County from 1991 and '92 -- ``at eight bucks apiece,'' she says -- and sent copies to local politicians, then-Gov. Pete Wilson, the media, California's Department of Health Services. She says she received no replies. She also says the formal complaints she filed with state agencies regarding her mother's treatment resulted in no action. ``Then one day I walked in to my mom's room and she's crying,'' Swan says. ``She tells me, `My bottom hurts.' When I pulled up her nightgown, I almost passed out. I could see her hip socket. She had bedsores that deep. She smelled grotty. I'm pulling off rotting flesh and dried feces. It was inhumane.''

Late one night, in January 1993, Swan walked in to her mother's room and says she found her naked on her bed, spread eagle and tied up with restraints.

``There was no blanket over her, the patio door was open and it was 40 degrees out,'' Swan says. ``She was crying, `Give me a blanket. I'm so cold.' '' Swan claims it was a retaliatory act by Creekside, which was sold shortly before Swan's suit was settled in 1995. She pulled her mother out of the facility that night and put her in private care. Not long thereafter, she filed suit.

During the two-month trial in 1996, Creekside denied it acted improperly in the cases of Swan's mother and other residents. But after a mistrial resulting from a dispute about the authenticity of medical records provided by Creekside, the sides reached a confidential settlement.

Many scrapbooks are devoted to her mom's suit.

``Here's mom,'' Swan says. She points to a photo of a hip so infected one can see bone.

Then Swan flips the page.

``This is six weeks later, in private care,'' she says, pointing to a photo of the same hip, but with the wound closed and without us. ``Look how much better she is. And Creekside people are telling me that bedsores aren't preventable. That's bulls-- .''

Swan's mother died in 1998 at age 97 in a private home in her native Utah.

While gathering data to support her mother's suit against Creekside, Swan finally got a response to her blizzard of mailing. It was from Dina Rasor, an East Bay investigator best known for exposing military spending excesses.

``Ila comes trotting into her kitchen with these armloads of death certificates,'' Rasor remembers, ``it was incredible. We, as investigators, walked into a gold mine. If it hadn't been for Ila, the (General Accounting Office) wouldn't have paid any attention.''

Swan sent Rasor all of the death certificates she compiled, and then Rasor and a Palo Alto lawyer helped Swan look for suspicious death certificates in all 58 California counties.

``Next thing I know,'' Swan says. ``I get a call from Senator Grassley telling me the GAO is going to hold hearings.''

-- -- --

When people speak of Swan, they don't mince words. Her supporters rave: -- ``I've never seen anyone more compassionate,'' Rasor says. ``She's like Mother Teresa.''

-- ``She's the Mother Jones of the nursing-home abuse movement,'' says Georgia Michell, an East Bay attorney who recently won a negligence judgment against a nursing home in Concord, partly thanks to Swan's help.

-- ``She's a martyr, almost saintlike,'' says Violet King, head of Nursing Home Monitors, a Illinois-based advocacy group.

Her detractors are equally as fervent:

-- ``She's the least credible person out there,'' says Macomber, the nursing home lobbyist. ``She's just in it for the money and she's not even sure what she's talking about.''

-- ``She's a zealot pervert,'' says state Assemblyman Brett Granlund, R-Yucaipa, during a nursing-home debate in Sacramento, referring to Swan's distribution of graphic videotapes of nursing-home abuse.

Others fault Swan's style, not the substance of her message.

Last October, Swan was not invited to a three-part workshop on elder care in Sacramento, sponsored by the American Association of Retired Persons, because of her bluntness.

Swan has passed out flyers equating elder-care abuse with Holocaust exterminations, showing emaciated bodies from nursing homes and concentration camps. Her videos are graphic, her attack unrelenting on nursing-home political action committees and the politicians who accept money from them.

During the last gubernatorial campaign, Swan hauled a giant billboard attached to her pickup truck and followed then-Attorney General Dan Lungren throughout the state. The sign had Lungren's face crossed out and the text read, in part, ``Lungren with 8 years in office has prosecuted 0 nursing home licensees.''

``I can't question Ila's motivation and dedication,'' says Tom Porter, California's AARP representative and organizer of the elder-care summit. ``But her style is questionable. We didn't invite her because we didn't want to turn the task force into a political thing.''

Lesley Ann Clement, an attorney specializing in nursing-home abuse, has known Swan since handling Swan's mother's case. She insists Swan's motives are pure, even if her delivery is harsh. Clement is representing Jehle's family in the suit against the home.

``Ila participates in a lot of (suits), but I can tell you she doesn't get squat out of it, other than the satisfaction of saving people,'' Clement says. ``She's never spent a penny off her mom's case. I know, because I handled the money (in a trust for Swan's mother's care). What Ila really wants is a pound of flesh.''

Swan refuses to soften her approach.

``You think I'm radical?'' Swan says. ``People who went against Hitler were considered radical, too. We've surpassed Hitler's kill in nursing homes. I tried going the normal route, and it didn't work.''

Relatives of nursing-home residents who call Swan at all hours of the day and night do not think she goes too far.

Georgia Hill asked Swan to help her mother, Eva Blacksher, who was in a nursing home in the Fruitvale section of Oakland. Swan met Hill at midnight at the home, and they assessed Blacksher's condition.

``Mom had already lost both legs because her feet were rotting on her,'' says Hill, who filed suit against the Fruitvale home in Alameda County in late June. ``Me and Ila, we looked at mom's behind and she had ulcers so bad you could put your fist up in there. Ila helped me find a good place in Orinda for my mom.''

Swan smirks when it's suggested she's a Mother Teresa figure. She says she just wants to improve nursing homes before she gets to an age at which she cannot take care of herself.

``If it weren't such a burden to my children, I'd give them instructions to put a gun in my mouth when the time comes,'' Swan says. ``I should be saving for in-home. I don't want maggots in my butt. I don't want to sit in my own urine. Hopefully, I'll know when the time comes soon enough so that I can pull the trigger on myself. That's an unforgivable sin, I believe. But I'll do it.''

-- -- --

Before sunrise on June 30, Swan's phone rang. She is accustomed to late night and early morning calls. She knows they almost always bring bad news.

It was Frances Jehle's daughter, Wendy Peet, sobbing uncontrollably. Jehle had died, and her daughter wanted Swan to come to the Vacaville nursing home to help until paramedics arrived. Swan grabbed her coat and her camera and bolted out the door.

At Jehle 's bedside, Swan and Peet say, they rolled Jehle over and saw two stage-three bedsores (four being the most severe). Swan snapped numerous photographs of Jehle and her blood-stained sheets, and she sent the photos to Wendy's lawyer and to the media.

Frances Jehle's death certificate lists natural causes for the death. According to Clement, a family-requested toxicology screening showed an elevated blood urea nitrogen level in the liver, which might indicate dehydration, and a low level of glucose, which might indicate starvation. Officials of the Vacaville home did not return phone calls.

``I know my mother was old and sick and had diabetes,'' Peet says. ``Before going there, she was in good shape. But she lost a leg after the sores. And now she's gone.''

Swan says she kept her composure at the nursing home -- until she returned to her home. Then she broke down and cried.

``I'm losing them left and right,'' Swan says. ``I can't work fast enough to save them.''

From: "Daily Republic Online" drnews@dailyrepublic.com Published 'Todays News' 7/26/01 Page 4 C

"Nursing home abuse could be stopped by a bullet"

I propose we just be up front and open about all this so that we can save even more of the elderly some weeks, months or years of misery.

We can save their loved ones weeks, months or years of strain in dealing with it. When an elderly person declines needing nursing home care, simply put a bullet in his or her head immediately. This would be a humane and a considerate end, and the old person would not have to endure the horrors of nursing home warehousing, bedsores, loneliness, sexual abuse and overmedication.

Their children or spouses would not endure frustration and emotional agony in trying to stop the abuse.

After medical administration of the bullet, give the warehouse___er, I mean nursing home chain___a check equal to 50 percent of the revenue it would have expected to "earn" under the old system.

The government, taxpayers and care givers would save 50 percent, but the corporations would still have funds necessary to meet "administrative cost"____i.e. CEO salaries. An added advantage to this plan would be that the tired, old fight about staffing ratios would be over and done with. Current staffing levels would be perfect for dealing with the number of nursing home residents under the new plan (none.) Similar 50 percent payments could be made to the pharmaceutical giants for supplying all the drugs required for overmedication.

The only point perhaps requiring further debate would be whether to expect the nursing home chains to continue to make campaign contributions from this reduced revenue stream, since their expenses would theoretically also be reduced. Or they could simply pay the politicians directly. I think the decision whether or not to adopt this new plain is a no-brainier. It is clearly a win-win-win-win proposition. Possible ancillary benefits that could be added. Have you seen the movie "Soylent Green"?

Contra Costa Times Tuesday, May 29, 2001

"Nursing home activist refuses to back down" Ila Swan doesn't worry about alienating people; she worries about the quality of residents' care

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MANORCARE LAWSUIT Ila Swan's lawsuit against ManorCare Health Service Inc. includes allegations of poor care at the company's nine California nursing homes, including the two it owns in Walnut Creek. Swan's lawsuit alleges that residents "can be observed with scaling skin and poor grooming, indicating a lack of grooming, bathing, and hygienic care -- indicating a lack of sufficient attention to care and fluid intake." "Residents can also be observed suffering from weight loss and from malnutrition that threatens their life and health.

Residents frequently lie in their beds in body waste." The suit lists several specific allegations against both Walnut Creek facilities. At ManorCare Health Services on Rossmoor Parkway, the suit alleges:

Residents wait unacceptable lengths of time for certified nursing assistants to answer call lights. Residents then sometimes attempt to go to the bathroom without assistance, injuring themselves. Workers failed to clean a resident's eyes for more than 24 hours when a "pus-like substance" accumulated in them, effectively blinding the woman.

A nursing assistant jarred a patient by poking the patient's genitalia. At ManorCare Health Service on Tice Valley Boulevard, the suit alleges: Workers failed to stop a patient with Alzheimer's from hitting a female resident with a belt.

A resident waited for 42 hours for an X-ray to investigate pain and bruising on her side. Many residents often wait an unacceptably long time to have soiled clothing or bed linens changed and to be fed. ManorCare Inc.'s corporate spokesman, Richard Rump, declined to comment on the allegations except to note that some of them apparently occurred as long as three years ago and that significant research was required before the company could answer the charges.

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By Thomas Peele TIMES STAFF WRITER

VACAVILLE -- Ila Swan raises hell.

Ila Swan once hung a sign outside of a nursing home that said, "Free maggots with every bedsore."

Ila Swan, a nationally known activist, goes after the nursing home industry the way Ronald Reagan once went after the Soviet Union. Evil Empire? Ila Swan fights the Evil Industry.

To a reporter, Swan spoke in placid terms about nursing homes for nearly 90 minutes, her words measured carefully in stories about lawsuits and suffering and bedsores as she rocked gently in a black chair, sometimes stopping to dig an unshod toe into her office's gray carpet.

But it became too much. Too many photos spread on the floor of open, infected wounds, black eyes and emaciated bodies. Too much pain.

"I want all this killing stopped," Swan bellowed. In her words, nursing home executives quickly became "industry scumbags" and "pigs." State health officials and other advocates? Industry bedmates. Politicians? Nothing more than industry pawns.

Welcome to Ila Swan's world. A 60-year-old grandmother and retired telephone company linewoman who used to climb poles the way most people ascend a front stoop, she sues nursing homes with religious zeal.

"I know I am doing right," she said. "They think I am terrible. I put their face in it."

In February, Swan won a whistle-blower lawsuit against Crestwood Convalescent Homes, forcing the chain to return more than $800,000 in Medicare money to the federal government. It drew the attention of Steve Berman, a high-profile Seattle attorney who won legal victories against the tobacco industry in 13 states.

He agreed to represent Swan against her newest adversary, ManorCare Health Services, which owns two nursing homes in Walnut Creek and more than 300 across the country. In a lawsuit filed this month in Los Angeles County Superior Court, Swan alleged horrid conditions in the Walnut Creek homes and in seven others the Ohio-based company owns in California.

Her journey to that court filing started in the mid-1990s, when she found her mother receiving bad care at a Vacaville nursing home, moved her, then helped her to sue.

It made her friends with a U.S. senator from Iowa, lawyers and private investigators. It brought coverage in Time magazine, contacts with nursing home advocates across the country and a Web site, IlaSwan.net.

But it never softened her unweathered edge.

When she testified before the U.S. Senate Committee on Aging, its chairman, Sen. Charles Grassley, R-Iowa, warmed to her and promised a fight.

One day soon after, she was in a car crossing the Bay Bridge toward San Francisco.

President Clinton came on the radio, talking about the need to fix nursing homes. The driver, Dina Rasor, a private investigator, realized that Clinton had snatched the political play from Grassley.

Swan, though, saw no such subtlety. She wanted to jump inside the radio, grab Clinton and demand why he now suddenly seemed so concerned after ignoring Ila Swan for so damn long.

"'I think he just read all your letters, Ila,'" Rasor said. Swan didn't laugh.

"I think she wanted to kill me,'' Rasor recalled recently. "Not everyone has Ila's sense of justice. She gets very frustrated with people who don't have her internal strength."

Swan, a Utah native, insists she never intended to become one of the nation's most unrestrained nursing home activists. But when she found her mother's bedsores growing worse, lying in her own waste day after day, Swan got active. A tropical depression grew into a raging hurricane overnight.

She encountered an unresponsive system. State health officials ignored her at first. So did politicians. Eventually, she moved her mother to a better home. Her mother sued and won a $775,000 settlement against the nursing home that mistreated her.

But Swan never stopped. "My phone kept ringing," she said. People read about her mother's suit and her feisty daughter. Swan started walking into nursing homes unannounced, wearing a wig and sunglasses to disguise her appearance and recording her observations on a hidden tape recorder.

Swan started flying around the country, and didn't like much of what she saw.

In Washington, she walked out of a National Citizen Coalition for Nursing Home Reform conference because nursing home administrators and lawyers also attended it, and because she learned the reform organization accepted funding grants from nursing home companies.

"They take money from those scumbags," Swan said. "I mean, come on. They're corrupt."

Elma Holder, the reform organization's founder, said of Swan, "Think she has done some good research that has been very useful." But, Holder added, Swan often expresses "hatred toward other advocates and individuals. Our styles are very different. I deplore that kind of advocacy. I am totally against her attacks on people."

But in Swan's world, no gray areas exist. Many people admire her.

"I think she's brought more attention to the nursing home realm in the last five years than anyone did in the last 40 years," said Violet King, who runs a nursing home patient advocacy group in Illinois.

"We now have statistics of abuse and neglect because of Ila. Before, everything was an 'isolated incident.' We've been empowered by Ila's guts, her risk to go forward with innovative things."

Ila Swan raises hell.

All material copyright of Hospice Patients Alliance ("HPA") unless otherwise credited.