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In Memoriam: Donna Myers Ambrogi

With great sadness, CANHR mourns the death of Donna Myers Ambrogi, who died at her home in Pilgrim Place in Claremont, California.

Donna was a close personal friend, a colleague and an inspiration. CANHR (BANHR) was born in the Ambrogi living room in San Francisco in 1983. She was one of the founders and first Board members of BANHR, while also founding and heading up the California Law Center for Long Term Care (CALTC). She was a brilliant, passionate social justice warrior for all of her adult life.

With her husband, Tom Ambrogi, Donna travelled the world working for social justice, including working for the first democratic election in South Africa that elected Nelson Mandela. Among many pieces of legislation spearheaded by Donna, was the first nursing home admission agreement law in California that extended the rights of nursing home residents upon admission.

Upon her “retirement” and move to Pilgrim Place, she was elected to the California Senior Legislature, served on CANHR’s Board of Directors and the Pilgrim Place Board and helped start a regional Medicare HMO – all of which involved improving the lives of others. Donna was a light that never stopped shining, and she leaves a void for those of us who knew her. Thank you, Donna, for sharing your advocacy and life with us.

CANHR's COVID-19 Coronavirus
News & Resources 

In an effort to keep you all better informed, we have created a website, specifically for COVID-19 information, news and resources related to Long Term Care. For the duration of this crisis, we are posting frequent updates there.

Home Equity Protection Program (HEPP)
funded by the State Bar of CA to prevent financial mortgage scams and more... Please read our FREE BOOKLET of Reverse Mortgage information.


Join our campaign to restore reasonable visitation to residents in long term care facilities.
Stockton Nursing Home Resident Walks Off and Killed by Train


Violation of the Month Archive

On February 24th, CANHR Executive Director Pat McGinnis testified at the California State Senate Committee on Human Services oversight hearing regarding State Oversight of Homes for Vulnerable Adults. To watch a video of the hearing, CLICK HERE or on the image to the left. Director McGinnis' testimony begins just over an hour and twenty four minutes into the proceedings.

New Developments

  • Congressional Committee Releases Report on Overdrugging Problem Ravaging Nursing Homes
    The House Ways & Means Committee has released a report examining the continued misuse of antipsychotic drugs in America's nursing homes. While the report is a much needed analysis of the awful state of chemical restraint use in nursing homes, the report is also very frustrating as it comes forty-five years after a seminal Congressional hearing talking about the same exact problems.

    The new report highlights that, despite a highly-touted eight year old CMS campaign to reduce antipsychotics in nursing homes, the rate of residents given antipsychotics remains stubbornly high at 20%. CMS continues to use a disingenuous measure for "appropriate" use of antipsychotics that understates the actual rate of misuse, especially now that it is gamed by nursing homes everywhere.

    Much of the report analyzes the enforcement of laws prohibiting misuse of antipsychotics and finds some very disturbing trends. Enforcement is down, with fewer citations issued against facilities for misusing antipsychotics and smaller fines when citations are issued. Most alarming, a miniscule 0.02% of cited antipsychotic misuse was found by government investigators to have committed any harm to the victims. This leads to a slap-on-the-wrist enforcement problem that encourages continued misuse. The 0.02% rate powerfully demonstrates that the enforcement system is broken when it comes to antipsychotic misuse.

    California does not fare well in the report. Citations for antipsychotic misuse in California nursing homes decreased 36% from 2016 to 2018 despite the fact that antipsychotic usage rates increased from 19.3% to 19.6%.

    This new report is a good reminder that chemically restraining residents remains business as usual in many nursing homes and that our laws prohibiting chemical restraints continue to be largely ignored. Until enforcement of the laws is prioritized, residents will continue to tragically suffer in harmful drug stupors.

    click to read more
    (posted July 29, 2020)
  • California Department of Public Health Endangers Lives and Mission of Nursing Home Inspectors
    The notoriously mismanaged California Department of Public Health (CDPH) is back in the news again for all of the wrong reasons. Not only has the Department now acknowledged that it has failed to regularly test for COVID-19 the inspectors surveying nursing facilities with outbreaks of the virus, but it has embarked upon a sweeping plan to undermine the independence and reliability of its own inspection program at a time when nursing home residents need rigorous enforcement most.
    (posted July 27, 2020)
  • Demand Outdoor Visitation at Nursing Homes Using Our New Template Letter.
    Outdoor visitation is now required in California nursing homes but many facilities have not gotten the memo. Here is a sample letter to use to distribute the memo and get outdoor visits for nursing home residents.
    (posted July 23, 2020)
  • Two Studies Find Strong Connection Between Nurse Staffing and COVID-19.
    Two new studies have found a close relationship between RN staffing and COVID-19 outbreaks and deaths in nursing homes. The first study reviewed reported COVID-19 infections in California through May 4 and identified three factors associated with increased risk of COVID-19 in nursing homes: higher numbers of past health deficiencies, larger facilities with more residents, and lower federal 5-star ratings. The strongest relationship, however, was RN staffing. Nursing homes with .75 hours of RN staffing per resident per day were half as likely to have a COVID-19 outbreak.

    The second study looked at COVID-19 outbreaks and deaths from COVID-19 in Connecticut nursing homes as of April 16. This study found a significant association between the extent of outbreaks (the number of COVID-19 cases a facility had, once it had a case) and four factors: federal 5-star ratings, the concentration of residents on Medi-Cal, the concentration of racial and ethnic minority residents, and RN staffing. RN staffing was also strongly associated with the number of COVID-19 deaths in facilities: every 20 minute increase in RN staffing predicted a 26% reduction in deaths. The study authors concluded that facilities with better compliance with care standards are better able to contain the spread of coronavirus.

    The two studies counter the ridiculous narrative, perpetuated by the nursing home industry, that nursing home quality is somehow not related to COVID-19 outbreaks. Of course, quality matters and RN staffing in particular is strongly associated with fewer cases and deaths. Hopefully, our federal and state policymakers are paying attention and will direct RN resources to nursing homes to combat COVID outbreaks among nursing homes.

    click to read more
    (posted July 20, 2020)
  • New Coalition Releases Brief to Oppose Immunity for Deadly Long Term Care
    The Coalition for the Protection of Residents of Long-Term Care Facilities has issued a new brief opposing immunity for long-term care facilities during the COVID-19 pandemic. Many states have already provided cover to facilities that neglected and abused residents during the pandemic. Now Congress and California are considering similar legislation. The brief lists actions Congress can take to protect, rather than forsake, long-term care facility residents.
    (posted July 15, 2020)
  • New Visitation Fact Sheet Released.
    CANHR has reviewed the various federal and California guidance regarding visitation in long term care facilities and synthesized the rules into a new fact sheet to guide residents and their families. The fact sheets highlight the types of visitation nursing homes and residential care facilities for the elderly must provide and under what conditions as well as the infection control protocols facilities may impose during visits. Download the Fact Sheet HERE (PDF).
    (posted July 13, 2020)
  • LTCCC Podcast Features #VisitationSavesLives
    A recent podcast from the Long Term Care Community Coalition takes on the tragedy of the visitation ban in long term care facilities. CANHR Staff Attorney Tony Chicotel and CANHR's #VisitationSavesLives campaign is featured in the podcast. The episode is called "The Eyes, Ears, and Voice: Why Nursing Home Visitation Saves Lives."
    (posted July 8, 2020)
  • New Policy from Department of Public Health Restores Some Visitation Rights in Nursing Homes.
    On June 26, the California Department of Public Health released a new policy regarding visitation that, for the first time since March, REQUIRES nursing homes to permit visitors for outdoor and indoor visits. Facilities with no current COVID-19 outbreak must permit outdoor visitation. Indoor visits must be permitted if a facility meets six criteria: 1. no current COVID-19 outbreak, 2. a decline in cases in the community, 3. no new COVID-19 cases in the facility for the past 14 days, 4. no staffing shortages and not using a COVID-19 staffing waiver, 5) an adequate testing plan per AFL 20-53, and 6) an approved COVID-19 Mitigation Plan. For indoor visits, only one designated visitor allowed per resident (per visit - more than one visitor may visit, just not at the same time). All visits (indoor or outdoor) must be scheduled in advance with visitors screened for fever or COVID-19 symptoms. All visitors must comply with social distancing (6 feet or more physical distancing), wear facial coverings, and permit staff monitoring to ensure compliance with infection control guidelines.
    The new policy may have been partially motivated by CANHR's ongoing #VisitationSavesLives campaign. Now that residents have some of their rights back, the campaign will advocate for better state enforcement as well as restoring the visitation rights of assisted living residents, who were not affected by the shift in state policy.
    (posted July 6, 2020)
  • Governor Signs Law Extending AB 1629 Reimbursement System for Skilled Nursing Facilities
    On June 29, 2020, Governor Newsom signed into law AB 81, a budget bill that extends the Medi-Cal reimbursement system for freestanding skilled nursing facilities through the end of 2022. Known as “AB 1629” for the 2004 legislation that created it, the failed payment system has been a magnet for unscrupulous operators who have profited at residents’ and Medi-Cal’s expense.

    The extension does not contain any of the reforms CANHR recommended, however, it is a somewhat reduced windfall for nursing home chains than they and the Newsom Administration had sought. The amended law provides aggregate rate increases of 3.62 percent through the end of calendar year 2020, 3.5 percent in calendar year 2021 and 2.4 percent in calendar year 2022.

    Additionally, skilled nursing facilities will receive increased Medi-Cal payments for any new federal or state mandates plus, under separate authority, a 10 percent rate increase retroactive to March 1, 2020 that will continue until the end of the emergency period.

    Collectively, these provisions will increase Medi-Cal payments to skilled nursing facility operators in California by more than $500 million through 2022. These generous increases are on top of multiple multi-billion dollar bailouts the federal government is providing to the nursing home industry.

    In addition to increasing payments to nursing home operators, the extension made other changes to the payment system. Some of interest include:

    • Beginning in 2021, requiring the Department of Healthcare Services (DHCS) to assess monthly penalties up to $50,000 when SNFs are found to be out of compliance with minimum staffing requirements, minimum wage laws or wage pass-through requirements.

    • Increasing penalties, imposed by the Department of Public Health, on facilities for failing to meet the nursing hours or direct care service hours per patient per day statutory requirements.

    • Requiring DHCS to audit facility costs and revenues that are associated with the COVID-19 Public Health Emergency to determine whether a facility has adequately used increased Medi-Cal payments associated with the emergency only for allowable costs.

    • Requiring a facility that received increased Medi-Cal payments associated with COVID-19 to provide any information requested by DHCS on emergency-related costs and revenues at the time and in the manner specified by DHCS; and requiring DHCS to recoup any amounts of increased Medi-Cal payments that were not used to support the delivery of patient care.

    • Requiring DHCS to convene a stakeholder process by September 1, 2021 to develop a successor supplemental payment or similar quality-based payment methodology to replace the existing program, to begin in 2023.

    A more complete summary of the changes to the payment system can be found here.

    The extension took effect immediately when signed on June 29, 2020.

    click to read more
    (posted July 7, 2020)
  • Great news! SB 1207 (Jackson) on Backup Power in Skilled Nursing Facilities Passes Senate by 36-0 Vote, Moves on to the Assembly!
    Today the California Senate unanimously passed Senator Hannah-Beth Jackson’s bill, SB 1207, to help save the lives of California nursing home residents during power outages that may result from public safety power shutoffs (PSPS), emergencies, natural disasters, and other causes. CANHR and Long Term Care Ombudsman Services of San Luis Obispo County are co-sponsoring SB 1207. The bill codifies existing federal standards that require skilled nursing facilities to have an alternative source of power to protect resident health and safety and maintain safe temperatures for 96 hours during any type of power outage. As the COVID-19 pandemic collides with wildfire season, the critical need to keep residents safe in their facilities and out of emergency shelters is greater than ever. Over 2,200 California nursing home residents have died already from the coronavirus. It has never been more apparent that California needs to do a much better job of protecting the lives of nursing home residents. SB 1207 moves next to the California Assembly, where it will likely be assigned to a policy committee and first be heard sometime during July.
    (posted June 22, 2020)
  • CANR Releases Ten-Point Plan to Reform California Nursing Homes
    This is CANHR's Ten-Point Reform Plan that responds to the nightmarish conditions California nursing home residents have faced throughout the pandemic and for years before the coronavirus arrived. The sweeping plan addresses longstanding failings that the pandemic has exposed for all to see, starting with the need to give top priority to helping people stay out of nursing homes. It also addresses living conditions, safe staffing, emergency preparedness, nursing home slumlords, bad actors, self-dealing schemes, justice for elder abuse victims and independence from the nursing home industry.
    Click HERE to download and read it (pdf).
    (posted June 8, 2020)
  • “The Doctors” Show Takes on Nursing Home Resident Dumping
    A recent episode of “The Doctors” reviewed the continuing problem of nursing homes that dump residents into hospitals and refuse to take them back. CANHR’s lawsuit against the State to stop this practice continues in federal court.
    Segment 1: "Nursing Homes Illegally Evicting Patients?"
    Segment 2: "Know Your Rights as a Nursing Home Patient"
    Segment 3: "How to Make Sure a Nursing Home is Reputable"
    (posted June 3, 2020)
  • Newsom Administration Plans to Gut Home and Community Based Services, Use Savings to Fund Large Increases for Substandard Nursing Homes
    Does California have the money to maintain its vital programs that are aimed at keeping people who need long term care at home and out of nursing homes?
    It turns out it does, but the Administration has decided to terminate, gut and slash those programs in order to further enrich unscrupulous nursing home operators who are using the pandemic as cover for their latest money grab at the Capitol.
    (posted May 26, 2020)
  • GAO Study Finds Persistent Subpar Infection Control and Enforcement in Nursing Homes
    A new GAO study has found an extraordinary number of nursing homes have been cited for poor infection control practices in recent years and state nursing home enforcement agencies almost never find these poor practices harmful. The GAO reports that 82% of the nation's nursing homes were cited for bad infection prevention in 2013-2017, ranging from staff members failing to wash their hands to failing to isolate sick and infectious residents. Almost half of all facilities were cited in multiple consecutive years, indicating a deeply persistent problem with infection control compliance.
    Equally striking, 99% of the thousands of citations were labeled by state enforcement agencies as "non-harmful" to residents, meaning they were not accompanied by any actual enforcement action. This slap on the wrist treatment for bad infection control practices tacitly encouraged horrible infection control in nursing homes which has contributed to the massive number of deaths residents are suffering now from COVID-19.
    The GAO study confirms that years of red flags regarding infection control in nursing homes were ignored, much to our detriment. Stronger enforcement of our infection control standards is desperately needed.
    (posted May 20, 2020)
  • Looking for something no longer here? View our "New Developments" archives

Need a Speaker?

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Note: Due to limited number of staff, CANHR may not be able to accommodate all requests outside of the Bay Area and Greater Los Angeles Area.