In This Issue
On October 30, 2014, the California State Auditor released a report condemning the Department of Public Health’s (DPH) systemic mismanagement of nursing home complaint investigations. Assembly Member Mariko Yamada and the Joint Legislative Audit Committee sought the investigation by the State Auditor earlier this year after embarrassing public reports that DPH often took years to complete investigations of severe abuse and neglect in nursing homes. CANHR called for the state audit in testimony at a legislative oversight committee on January 21, 2014.
The central finding of the report – California Department of Public Health: It Has Not Effectively Managed Investigations of Complaints Related to Long-Term Health Care Facilities – is that, as of April 2014, DPH had more than 11,000 open complaints, many of which had high priorities and had remained open for an average of nearly a year. When nursing home residents die from neglect or suffer from abuse, DPH is usually nowhere to be found.
The report documents numerous other DPH failings related to complaint investigations and makes reasonable recommendations for reform, including a call to establish a specific time frame for completing complaint investigations. The defiant DPH response, signed by Kathleen Billingsely for DPH Director Dr. Ron Chapman, rejects this recommendation without explanation. Elaine Howle, the State Auditor, ends the report by criticizing DPH for its lack of accountability. She states: “We believe that Public Health’s lack of accountability has contributed to its district offices’ failure to complete investigations within reasonable time periods.”
DPH leaders appear immune to accountability. The new report by the State Auditor is the third report she has issued since 2007 that raises serious concerns about DPH’s oversight of nursing homes.
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Nursing home residents and their family members often worry about losing their rooms or their Medicare or Medi-Cal status if they leave the facility for brief periods of time. While the rules for Medicare and Medi-Cal differ, both programs will permit, and reimburse the facility for, short leaves – depending on how long the leave is. This is particularly important during the holidays, when relatives want nursing home residents to join in the family festivities.
The Medicare Policy Manual, Chapter 1§ 22.214.171.124, states that residents who leave the facility for an “outside pass or short leave” can do so without losing their coverage. If they return by midnight, the facility can bill Medicare for the day. If the resident is gone overnight (past midnight) and returns the next day, this is considered a leave of absence and the facility can bill the beneficiary to hold the bed during an absence. In these cases, you should ask the facility what the cost will be, since the daily rate at a nursing home can be high.
Under Medi-Cal rules, a leave of absence (LOA) of up to 18 days per calendar year can be granted to a Medi-Cal resident of a nursing home in accordance with the resident’s plan of care, and the facility will continue to be reimbursed for care. Up to 12 additional days of leave per year can also be granted under certain conditions. (22 CCR §51335) This is a much more liberal leave policy than Medicare, but it is also subject to certain restrictions. The resident, family members and/or friends should ensure that provisions for leaves of absences are included in the resident’s care plan.
On October 24, four Bay Area assisted living providers were issued more than $3 million in citations by Labor Commissioner Julie Su. The facilities -- run by Common Destiny Care Homes in Fremont, Florian White Dove Care in Brentwood, Abraham Rest Home Inc. and Sanchez-Abraham Corporation in Walnut Creek – were penalized for minimum wage, overtime, and rest period violations. Caregivers at Common Destiny often worked up to 17 hours per day. They were required to report to work (unpaid) the night before a shift began, sleep on a sofa bed in the garage, and work during their designated sleeping hours. Wages for employees at all four facilities were as low as $5.00 per hour.
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On October 27, 2014, Kaiser Health News reported that Los Angeles County Department of Public Health officials allegedly downgraded three citations involving nursing home residents who died from neglect. Two of the nursing home residents were very young children – a three-year old girl and a four-year old boy – who died in 2012 after their breathing tubes became disconnected at Totally Kids Specialty Healthcare, a Sun Valley nursing home. Investigators found that the facility failed to monitor the children closely and to keep them safe. The other death involved a 30-year old resident of Verdugo Valley Skilled Nursing and Wellness Centre in Montrose who died in 2010 because the facility failed to closely monitor the effects of blood thinning medications he was taking. In all three cases, investigators had originally sought class “AA” citations (which carry fines of up to $100,000 for violations that directly cause a resident’s death), but LA County officials allegedly reduced the penalties to class “A” citations that resulted in much smaller fines. In addition to chopping the penalties, the downgrading of the citations protected the nursing homes from required actions to revoke or suspend their licenses.
Earlier Kaiser Health News articles triggered a county audit report in August that reported DPH supervisors regularly downgrade or delete citations and deficiencies, often without communication with the investigators. In the wake of the latest article, Kaiser Health News reported on October 29, 2014 that the County Board of Supervisors ordered DPH to provide a report on inspection procedures and the percentage of inspectors’ recommended citations that had been changed by their bosses.
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CANHR's publication "Medi-Cal Recovery: What you Need to Know and How to Avoid It," is available for free download in English, Spanish, and Chinese. Free printed booklets are available to individual consumers, legal services programs, Ombudsmen programs and other non-profits.
For profit companies will be charged $1.00/booklet to cover the cost of printing and shipping.
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Non profit organizations and individual consumers:
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Saturday, November 8, 2014
Crowne Plaza Hotel, Foster City
Sponsored by: Alzheimer's Association of Northern California and Northern Nevada
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Sunday, November 9, 2014
Jewish Community Center of San Francisco
3200 California Street, San Francisco, CA 94118
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