In This Issue
On February 26, 2015, Assemblymember Kevin McCarty of Sacramento introduced AB 927, a CANHR sponsored bill that directly responds to the Sacramento Bee’s remarkable three-part series in November 2014 on the performance of California nursing home chains. The series, Unmasked: How California’s Largest Nursing Home Chains Perform
, exposed the troubling performance of many of these chains, the great challenges consumers face in discovering who really owns nursing homes they are considering and the Department of Public Health’s failure to keep unfit chain operators from acquiring large numbers of California nursing homes. AB 927 would strengthen California laws governing acquisition of nursing homes, suitability requirements for operators and disclosure to the public on who owns nursing homes. You can help CANHR pass this vital legislation by sending a support letter to the Assembly Health Committee, which is expected to be the first committee to hear the bill.
CANHR is also sponsoring an important bill on ownership disclosure and suitability of ownership for Residential Care Facilities for the Elderly (RCFEs). Over 90 percent of RCFEs are for-profit entities, many of which operate multiple facilities. However, Community Care Licensing is often unaware of other facilities owned and operated by applicants for a license and prior histories of substandard care at these facilities. AB 601 (Eggman) would establish specific suitability of ownership criteria and require applicants for a RCFE license to disclose complete ownership information, including disclosure of any person(s) who holds a 10 percent or more beneficial interest in the facility and all related entities. It is expected that AB 601 will be heard by the Assembly Human Services Committee in March. Your support and letters to the Committee are also needed for this bill.
Read the bill
Link to CA Assembly Human Services Committee members
In a major victory for the Center for Investigative Reporting and for advocates and the public, California's Supreme Court reversed an appellate court ruling that permitted the Department of Public Health to heavily redact citations issued to state owned long term care facilities for the Developmentally Disabled. A Public Records Act request to DPH in 2011 resulted in DPH releasing a total of 55 citations, most of them so heavily redacted that the pages were entirely blackened out. The Supreme Court reversed and remanded with instructions for the Court of Appeal to deny DPH's petition for writ of mandate.
Read the Decision
On January 23, 2015, the Department of Veterans Affairs (VA) published proposed regulations
that would make major changes to eligibility rules governing the Aid & Attendance Pension. The proposed regulations seek to establish a new net worth limit that would be used to determine financial eligibility and would create a 36-month look-back period on asset transfers made by pension applicants. Under the proposed regulations, veterans who transfer or dispose of assets to qualify for the pension during the three-year look-back period could face a penalty of up to ten years of ineligibility. The public has until March 24, 2015 to submit comments to the VA on the proposed regulations. CANHR will release a fact sheet shortly on this issue.
The Governor proposes to extend the Medi-Cal rate system for skilled nursing facilities
– known as AB 1629 – through FY 2019-20 with compounded increases of 3.62 percent each year. Under the proposed five year extension, California’s annual Medi-Cal payments to skilled nursing facilities would grow to more than $5 billion by FY 2019-20, a near doubling of the Medi-Cal rates paid to skilled nursing facilities in 2004 when the AB 1629 rate system was first enacted.
In contrast, the minimum staffing levels for skilled nursing facilities have not been adjusted since 2000 and remain at 3.2 nursing hours per resident per day, a standard that was considered inadequate when it was enacted more than 15 years ago. Today, this standard is dangerously deficient. CANHR opposes extending the AB 1629 rate system unless it is accompanied by annual increases to California’s minimum staffing requirements that raise the minimum staffing requirement to at least 4.1 nursing hours per resident per day, including at least 0.75 RN hours per resident per day, by FY 2019-20.
In more budget news, Governor Jerry Brown’s proposed budget for FY 2015-16 would add more than $30 million and about 260 positions for the Licensing & Certification Division of the California Department of Public Health and its subcontract with Los Angeles County. The Department’s primary justification for the huge increase in its workforce is that its prior methodology failed to consider that inspectors were needed to investigate its vast backlog of complaints. In other words, the Department has allowed thousands of complaints involving nursing home abuse and neglect to languish for years because its leaders could not competently perform the most basic assessment of its staffing needs.
On February 20, 2015, state officials announced that the Governor has appointed Dr. Karen Smith, MD MPH, as the new Director of the California Department of Public Health. Dr. Smith replaces Dr. Ron Chapman, who announced his resignation in December. Currently, Dr. Smith is the Deputy Director for Public Health for Napa County.
Earlier in February, Kathleen Billingsley, who has been second-in-command at the Department, announced she was resigning. Ms. Billingsley was most directly responsible for the dysfunction within the licensing and certification division. It remains to be seen whether the Governor will replace her with someone who has the qualifications, experience and will to transform the licensing and certification division into a consumer protection agency that is worthy of the public’s trust.
On February 20, 2015, The Centers for Medicare and Medicaid Services (CMS) implemented initial changes to Nursing Home Compare to improve the accuracy of its not so reliable 5-Star rating system. The changes make it moderately harder for nursing homes to achieve high ratings in quality measures and nurse staffing, two components of the ratings that rely on unaudited, self-reported information submitted by nursing homes. Importantly, CMS added antipsychotic drug use to the factors that determine a nursing home’s Quality Measure rating. The changes are the first among several steps planned to increase the reliability of ratings that have often shown wide discrepancies – between residents’ experiences and state inspection results on one hand, and nursing homes’ self-reported information about their nurse staffing levels and performance on federal quality measurements on the other.
The CMS changes respond to an August 24, 2014 article by the New York Times
that exposed how poor quality nursing homes are able to game the CMS rating system and gain high ratings by presenting false information on the quality of their care and staffing levels.
Read CANHR’s Statement on the CMS Nursing Home Compare Changes
Read CANHR’s Statement “Why We Need Payroll Data …”
In another regulatory development, the Administration on Aging published final regulations for the long term care ombudsman program
on February 11, 2015. The regulations, which take effect on July 1, 2016, fill a decades-old void for standards to govern ombudsman programs. They address numerous issues including independence of the program, public policy advocacy, response to complaints, the ombudsman’s role as an advocate for residents, confidentiality, the relationship between the state office and local ombudsman programs, conflicts of interest, interference with the ombudsman and others.
The regulations will certainly be helpful in some ways if they are enforced but their concentration of authority in the state ombudsman office is a concern in California.