ST. LOUIS - A review of government documents and court records indicates hundreds of elderly patients in nursing homes are dying from neglect, according to a newspaper report.

The St. Louis Post-Dispatch, in a weeklong series that began Sunday, reported that the quiet epidemic is rarely detected by government inspectors, appraised by medical examiners, or investigated or prosecuted by law enforcers.

Most of the deaths are caused by neglect traced to caregivers whom the elderly rely on for food and liquid, and for turning them in their beds to prevent life-threatening sores, investigators and researchers say.

The latest national compilation of more than 500,000 nursing home deaths - for 1999 - lists starvation, dehydration or bedsores as the cause on 4,138 death certificates.

Most of the deaths can be traced to an inadequate number of nurses and aides; the Department of Health and Human Services reported to Congress this year that nine of 10 nursing homes have inadequate staff.

The Post-Dispatch interviewed about 700 professionals for its stories, including nurses, doctors, patient advocates, death investigators, nursing home operators and prosecutors.

Many workers say they are unwilling to accept poverty-level wages for unpleasant, demanding work that often requires mandatory overtime or double shifts. Corporate focus on the bottom line, the newspaper reported, frequently requires managers to operate homes with skeleton staffing because the industry says it lacks enough government money to provide proper care.

The American Health Care Association, the lobbying group for most nursing homes, said in a statement that the newspaper unfairly included deaths from neglect with deaths from natural causes.

"AHCA states unequivocally that any incident of neglect or abuse is unacceptable, but drawing a link of patients passing away from these maladies as a result of alleged poor care is simply irresponsible," the statement said.

In 1998, the General Accounting Office assigned three nurses and a physician to determine what actually killed 62 people who had died in California nursing homes. The GAO probe determined that 34 of the 62 had received "unacceptable care" and had died of dehydration, malnutrition or infections from bedsores.

A year later, Little Rock, Ark., coroner Mark Malcolm reviewed about 100 questionable nursing home deaths that occurred from 1993 to 1999. He determined that more than 30 percent of the death certificates listed an incorrect cause of death.

The finding prompted the Arkansas Legislature to immediately pass a law - the only one in the nation - requiring nursing homes to notify a coroner of every death.

A Post-Dispatch examination of hundreds of court cases nationwide found that the vast majority of death certificates for nursing home residents attributed the deaths to natural causes such as pneumonia, heart attack and - in some cases - "cessation of breathing," "heart stopped," "old age" or "body just quit."

"Some physicians go to amazing lengths to avoid admitting that by omission or commission, the nursing home killed these people," said Tim Dollar, whose law firm in Kansas City is Missouri's largest litigator of nursing home deaths.