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Who Is Minding The CCRC Ethics Store?

By Lillian L. Hyatt, M.S.W., and a Resident of a CCRC

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Excerpted from the Spring 2006 The CANHR Advocate newsletter

I contacted the California Association of Homes and Services for the Aging to ask what happens when a Chief Executive Officer of a CCRC behaves unethically towards a CCRC resident? Who is in a position to review the C.E.O.’s actions? I interviewed Debby Pate–Newberry, Director of Communications, Publications and Communications Outreach at CAHSA and I asked her, “How can residents ask for a review of their C.E.O.’s actions by a CAHSA Ethics Committee?” Her reply, “CAHSA has no Ethics Committee.” This answer was very surprising since the national organization that CAHSA belongs to, the American Association of Homes and Services for the Aging, does have an Ethics Committee. However, according to Ms. Pate–Newberry, CAHSA, the trade organization representing non–profit CCRC’s in California, does employ three lobbyists. But they do not have an Ethics Committee!

A C.E.O. of a CCRC should answer to its Board of Directors. Unfortunately, board members are too often invited to join the Board by the C.E.O., and act as a rubber stamp for the executive’s decisions. This situation brings to mind the failures of the Enron and WorldCom boards to curb the financial harm their C.E.O.’s did to employees’ pensions and jobs as well as stockholder’s savings. Even the S.E.C. arrived too late to save hapless victims. The California Department of Social Service’s Continuing Care Contracts Branch (www.calccrc.ca.gov/, 744 P St., MS 10–90, Sacramento, CA 95814, (916) 657–2592) regulates CCRCs. The Branch can investigate allegations of resident rights violations and can issue fines, but few complaints are made, and even fewer fines are imposed.

It is clear from my experience that no one in government, or the CCRC industry is minding the CCRC Ethics Store. In the present climate, C.E.O.s appear to be an ethical law unto themselves. Most CCRC residents are in their eighties and nineties and do not have the energy or inclination to make complaints or to demand changes in the system. For their own peace of mind or for real or imagined fears of being labeled as troublemakers or being retaliated against for speaking out, they adhere to the CCRC “Code of Silence.”

To break this “code of silence,” residents must demand the highest ethical governance standards and providers must renew their commitment to such standards. Ethical governance is high on the California Continuing Care Residents Association’s agenda. Some solutions suggested by CALCRA (www.calcra.org) in an article entitled “CCRC Governance” (CALCRA News, Summer 2005) are: “The majority of Board members shall be ‘independent’ as defined in the California Corporation Code. The Board shall adopt and enforce a conflict of interest policy… The Board’s nominating Committee will be composed of independent directors… Whistleblower’s policies and procedures shall be in place.” CAHSA’s draft Policy Statement on CCRC Transparency, Accountability and Governance concurs that the majority of Board members be independent and that whistleblower policies and procedures be in place. This is a step in the right direction, but the policy is voluntary and only applies to members of CAHSA.

Prospective CCRC consumers and their families must check carefully, not only the obvious issues of safety, good care, staffing, and history of meeting basic regulatory standards found on the California Advocates for Nursing Home Reform website (www.canhr.org, but also the ethical practices of the CCRC provider before signing a contract for a promise of lifetime care.