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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.

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Violation of the Month Archive

New Developments

  • Governor Newsom Vetoes CANHR Co-sponsored Bill Requiring Skilled Nursing Facilities to Keep Residents Safe During Power Outages
    On September 25, Governor Newsom vetoed SB 1207, a critically important bill by Senator Hannah-Beth Jackson that would have required skilled nursing facilities to have an alternative source of power to protect resident health and safety and maintain safe temperatures for at least 96 hours during any type of power outage. Senator Jackson’s bill – The Nursing Home Resident Safety Act – had near unanimous, bipartisan support in the Legislature and was a priority measure for the Senate Wildfire Working Group. SB 1207 was co-sponsored by CANHR and Long Term Care Ombudsman Services of San Luis Obispo County and supported by many advocacy, human service and governmental organizations. Read CANHR’s September 28, 2020 press release on the veto
    (posted September 28, 2020)
  • White House Commission Urges Feds for More Resources (But Not Enforcement) in Nursing Homes
    The White House's Coronavirus Commission on Safety and Quality in Nursing Homes released an extensive report reviewing lessons learned from the COVID-19 pandemic and making recommendations to improve safety in nursing homes related to infection control. The report sets forth dozens of potential "action steps" for the Centers for Medicare and Medicaid Services (CMS) and other federal and state agencies to take to foster better infection control involving:
    - COVID-19 testing;
    - providing PPE and training staff to use it;
    - updating resident visitation and cohorting policies to be more sensitive to the balance between safety and quality of life; and
    - supporting staff/caregivers.
    Essentially, the report calls for more funding and guidance from the government to nursing homes. The report is notably missing recommendations regarding better enforcement of nursing home standards of care and are meant to reduce the spread of infection and enhance resident well-being.
    Commission member Eric Carlson of Justice in Aging refused to endorse the report, instead writing a three-page rebuke of the report's failures. Eric writes "[the report] recommends dozens of obligations for the federal government, but does little to set higher standards for nursing homes, or to ensure nursing home accountability." The report sets up CMS to act as financial supporter, consultant, and educator to nursing homes rather than its legal role as an enforcement agency charged with consumer protection. A similar effort to transform regulators from enforcers to job coaches has taken root in California and threatens to further degrade regulatory compliance.
    (posted September 28, 2020)
  • Health Affairs Study: Lower COVID Mortality Rates at Unionized Nursing Homes
    A new study from Health Affairs shows that nursing homes with unionized staff members have had 30% fewer resident deaths from COVID-19 than facilities without unions. In addition, the unionized nursing homes had a 42% smaller COVID infection rate than homes without unions. The study reviewed COVID cases in New York nursing homes from March through May 2020. The authors of the study pointed out that unionized nursing homes benefited from having greater access to PPE, such as N95 masks and face shields, and generally provide better care historically than nursing homes without unions. In addition to the lack of union presence, the study found that facilities fared worse on COVID-19 when they were part of a nursing home chain chain or had poor CNA staffing.
    (posted September 14, 2020)
  • Urge Governor to Protect Nursing Home Residents from Deadly Power Outages
    Please help support SB 1207 (Jackson) by urging Governor Newsom to sign it. This critical bill codifies 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. CANHR and Long Term Care Ombudsman Services of San Luis Obispo County are co-sponsoring SB 1207.
    Click to Read More
    (posted September 9, 2020)
  • California Department of Public Health Issues New Visitation Guidance
    On August 25, the California Department of Public Health (DPH) issued All Facilities Letter 20-22.4 outlining some significant changes to the State’s ever-evolving guidance relating to visiting nursing homes and other health facilities during the COVID pandemic.
    Click to Read More
    (posted September 3, 2020)
  • New Research: Nursing Homes Inflate CMS "Quality Measures"
    It should surprise nobody to hear that new research finds nursing homes inaccurately report the conditions of their residents when submitting "quality measure" data to the Centers for Medicare and Medicaid Services. The self-reported data is used as one of three major components to a facility's federal 5-star rating. For years, nursing home resident advocates have argued that any ratings system should not rely on unaudited, self-reported data from the nursing homes themselves because they have an incentive to report inflated data. In the new research, quality measure data was compared to Medicare claims data for nursing home residents who were hospitalized. The comparisons demonstrated that nursing homes substantially underreport the number of residents who develop pressure sores while in the facility. The data also showed inaccurate reporting regarding urinary tract infections (UTIs) and resident falls.
    (posted August 31, 2020)
  • 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)
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