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Visitation, No Excuses - CMS Restores Full Visitation Access in Nursing Homes!

Citing high COVID-19 vaccination rates for residents and staff and proclaiming that “continued restrictions on this vital resident’s right [visitation] are no longer necessary,” the Centers for Medicare and Medicaid Services (CMS) has restored the right of residents to visitors of their choosing whenever they want. The new CMS guidance prohibits facilities from: - limiting the frequency of a residents’ visits,
- limiting the duration of a residents’ visits,
- limiting the number of a residents’ visitors,
- confining visits to particular hours of the day, or
- requiring advance scheduling of visits.

Additionally, the guidance clarifies that visitors must be allowed during any COVID-19 outbreak or outbreak investigation.

While the guidance maintains recommendations regarding infection prevention during visitation, the bottom line is each “resident must be allowed to receive visitors as he/she chooses.”

EVENTS

CANHR Zoom Town Hall:
Upcoming Changes to Medi-Cal

Thank you to our co hosts, the Center for Health Care Rights (CHCR) and Disability Rights California (DRC), and thank you to the representatives from from the Department of Health Care Services (DHCS).

CANHR Zoom Town Hall:
Ho, Ho, No: Visitation in Long Term Care
Facilities During the Holidays

Thank you to our guest speakers from the Essential Caregivers Coalition.

During the past year, residents of long-term care facilities and their family members faced the unimaginable. COVID-19 took the lives of over 13,000 nursing home and assisted living facility residents and staff in California and turned bad facilities into some of the most dangerous places in the state. Unable to visit residents, family members watched their loved ones deteriorate from isolation, lack of adequate staff and lack of adequate care. Throughout this terrible year, CANHR remained open and worked tirelessly to assist the thousands of residents, family members, social workers, and ombudsmen, law enforcement and state legislators who called our hotline or emailed their concerns.

Please read our complete letter HERE and stories of our consumer advocacy during the pandemic HERE. Join our struggle. Please donate generously. With your donation, we can continue our advocacy for all long term care residents.

CANHR Job Opening:
Receptionist/Administrative Assistant

To read more details and see the instructions for applying, please visit THIS PAGE. You can also download a PDF of the Receptionist/Administrative Assistant job details HERE.

CANHR Job Opening:
Staff Attorney

To read more details and see the instructions for applying, please visit THIS PAGE. You can also download a PDF of the Staff Attorney job details HERE.

WE HAVE MOVED

CANHR has moved to our new location in Berkeley. If you have difficulty reaching our Consumer phone number at 1-800-474-1116, please try 1-415-974-5171. There has been no disruption to our online services, so you can always reach us via canhrmail@canhr.org, or our online feedback/contact form HERE. Our new mailing address is: CANHR, 1803 6th Street, Berkeley, CA 94710

CANHR's COVID-19 Coronavirus
News & Resources 

In an effort to keep you all better informed, we have created a website, https://canhrnews.com/ 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.

 

#VisitationSavesLives
Join our campaign to restore reasonable visitation to residents in long term care facilities.
 
Hollywood Premier Dumps Resident For NOT Having COVID-19

Read More...


Violation of the Month Archive

New Developments

  • Court Finds State Has "Endemic Inability" to Finish Complaint Investigations in Timely Manner
    On November 15, San Francisco Superior Court judge Ethan Schulman granted a Writ of Mandate against the California Department of Public Health (CDPH) for failure to complete nursing home complaint investigations within the 60 day timeframes imposed by law.  Finding that CDPH "has not complied with the statutory deadlines in numerous respects" and that its noncompliance is "institutional and longstanding," the Court ordered CDPH to develop a written plan to start complying with the law.  The deadlines for complaint investigation have been around for years but complainants still routinely wait months and months, and sometimes years, for their complaints to be resolved.

    The lawsuit against CDPH was brought by Foundation Aiding the Elderly (FATE) which assists clients in filing nursing home complaints and having them resolved satisfactorily. 
    (posted November 23, 2021)
  • Visitation, No Excuses - CMS Restores Full Visitation Access in Nursing Homes!
    Citing high COVID-19 vaccination rates for residents and staff and proclaiming that “continued restrictions on this vital resident’s right [visitation] are no longer necessary,” the Centers for Medicare and Medicaid Services (CMS) has restored the right of residents to visitors of their choosing whenever they want. The new CMS guidance prohibits facilities from:

    - limiting the frequency of a residents’ visits,
    - limiting the duration of a residents’ visits,
    - limiting the number of a residents’ visitors,
    - confining visits to particular hours of the day, or
    - requiring advance scheduling of visits.

    Additionally, the guidance clarifies that visitors must be allowed during any COVID-19 outbreak or outbreak investigation.

    While the guidance maintains recommendations regarding infection prevention during visitation, the bottom line is each “resident must be allowed to receive visitors as he/she chooses.”
    (posted November 16, 2021)
  • Residents Awarded $13.5 Million Following Four-Month Trial Against Parkview Healthcare Center
    A California jury sent a strong message to Parkview Healthcare Center in Hayward and Mariner Health Care, its parent company, that chronic understaffing and fraudulent record-keeping will not be tolerated. Ten nursing home residents were awarded $8.9 million in punitive damages on top of $4.6 million in compensatory and wrongful death damages awarded at trial in a lawsuit involving neglect, negligence and repeated violations of residents’ rights. The jury sided unanimously with the residents, finding that the rights violations, neglect and negligence were committed with fraud. At trial, the residents were represented by Susan Kang Gordon of the Law Office of Susan Kang Gordon, Jennifer Fiore of Fiore Achermann, and Jody Moore of Johnson Moore.
    Read the Mercury News coverage: Hayward nursing home, parent company must pay almost $20 million for neglecting patients, jury says
    (posted November 05, 2021)
  • Los Angeles County Office of Inspector General Issues Final Report on Skilled Nursing Facility Oversight and Accountability
    On October 12, the Los Angeles County Office of Inspector General (OIG) issued a voluminous final report – Improving Oversight and Accountability Within Skilled Nursing Facilities – of a more than year-long investigation triggered by the devastating death toll in LA County nursing homes during the pandemic and the horrific history of neglect in these facilities that goes back decades. The final report tells the story of life-threatening conditions in some nursing homes and inhumane conditions in others, dysfunctional oversight, downgraded deficiencies, complaint investigations being closed prematurely, failure to make required elder abuse referrals, improper backdating of records, complex chain ownership structures and ineffective penalties. 

    Some of its 39 recommendations are: establishing a permanent Skilled Nursing Facility Task Force; supporting safe staffing requirements; creating a comprehensive county-wide SNF crisis mitigation and response plan; and revising its Health Facility Inspection Division’s mission statement to prioritize resident health and safety above all else and to commit to transparency, accountability and public engagement. Notably, it also urges the County to support passage of AB 1502 (Muratsuchi), the CANHR-sponsored nursing home ownership reform bill, and to explore setting up its own system to thoroughly screen nursing home owners.
    (posted October 22, 2021)
  • Nursing Home Oversight, or Lack Thereof, Called Out by Legislature
    On October 5, the Assembly Health Committee held an informational hearing on nursing home oversight.  Several critical topics for nursing home residents were explored, from ownership and California's zombie licensing system to the Department of Public Health's (DPH) weak enforcement and oversight.  Long story short, DPH is not doing its job and its failures contribute to resident harm and misery.

    You can watch the hearing, in its entirety, here: https://www.assembly.ca.gov/media/assembly-health-committee-20211005/video.  Or you can watch attorney Kim Valentine's testimony on behalf of the Consumer Attorneys of California or CANHR senior staff attorney Tony Chicotel's testimony separately.
    CalMatters and LAist both posted good summaries of the hearing.
    (posted October 8, 2021)
  • Vaccine Mandates for RCFE Workers Starts November 30
    Following a state and federal requirement for nursing home staff to be vaccinated for COVID-19, the state Department of Public Health has issued a second order covering staff of adult and senior care homes, including Residential Care Facilities for the Elderly (RCFEs).  The order requires all staff, outside care providers, and other workers who come into the facility to be fully vaccinated by November 30.  The Department of Social Services issued a notice to adult and senior care homes, telling them of the new mandate.
    (posted September 29, 2021)
  • CANHR Joins Labor and Civil Rights Organizations Supporting the Rights of LGBTQ Long Term Care Residents
    CANHR has joined with Justice in Aging and LGBTQ Senior Organizations to submit an amicus brief to the California Supreme Court, asking the court to review a Court of Appeal decision that invalidated the “pronoun provision” of the LGBT Long Term Care Facility Residents Bill of Rights.  The brief supports the argument of the Attorney General and joins other amici in requesting review of the lower court decision.

    The brief we signed argues that the Court of Appeal mischaracterized the pronoun provision.  This provision makes it unlawful for a long-term care facility staff member to “[w]illingly and repeatedly fail to use a resident’s preferred name or pronouns after being clearly informed of the preferred name or pronouns,” and the brief argues that other settings where deliberate misuse of pronouns has been found to be discriminatory support the enforcement of the statute.  The particular circumstances of LGBTQ seniors make protection of their rights vital, since they may have more limited choices about how to receive necessary care because they are less likely than non-LGBTQ seniors to have children or other family members available to provide in-home care.  Obtaining assistance should not require giving up the right to be treated with respect.
    (posted September 29, 2021)
  • A Tale of Nursing Home Taxpayer Ripoffs in Three Acts
    SEIU California recently released a slideshow summarizing some of the schemes used by nursing homes to hide their profits and skimp on resident care.  Facilities in California increasingly use vast networks of corporate shell companies and pay inflated rents and service charges to themselves to siphon more than one billion dollars a year.  Facilities use these "related party" expenses to drive down their operating margins, inversely proportional to their payments to themselves, so their owners can claim they need more taxpayer money.  The result is owners making more money while residents suffer more neglect.  Without full transparency of related party expenses, California will continue to be ripped off.  SB 650 (Stern), a bill to promote more nursing home financial transparency, is on the governor's desk and we urge him to sign it.
    (posted September 27, 2021)
  • Vaccination Rates for Nursing Home Staff and Residents Now Available on Care Compare
    The Centers for Medicare & Medicaid Services (CMS) announced in a September 21, 2021 press release that it has added a new feature to its Care Compare website to make it easier to check COVID-19 vaccination rates for nursing home staff and residents. The information is intended to help people make informed decisions when choosing a nursing home. To access the vaccination rate data, search a nursing home’s zip code or city on Care Compare, click on the name of the nursing home, then scroll down to click “View COVID-19 Vaccination Rates” to see the data. The information is intended to help people make informed decisions when choosing a nursing home.

    CMS is updating the data weekly. Medicare and Medi-Cal certified nursing homes have been required to report weekly COVID-19 vaccination data for both residents and staff since May, and CMS has been posting the information on the CMS COVID-19 Nursing Home Data website. The new vaccination rate tool on Care Compare is in addition to the data being posted on the COVID-19 Nursing Home Data website.
    (posted September 22, 2021)
  • CMS Trashes State Abandonment of Dumped Residents
    In a major development for CANHR's six-year effort to force the State of California to enforce its own orders requiring nursing homes to readmit unlawfully evicted residents, the federal Centers for Medicare and Medicaid Services (CMS) has opined that California's position in the case is mistaken.

    In 2015, fed up with an eviction hearing system that gave residents paper victories but not justice, CANHR and three residents who had been illegally dumped into hospitals sued the State arguing that its hearing system was a sham. In the subsequent years of litigating the case, state officials have spent enormous amounts of time and money to defend its abandonment of illegally evicted residents.  

    Recently, the judge in the case asked CMS for its opinion on the merits of the State's arguments. In response, CMS explained that "CMS has repeatedly informed California that [CMS] does not believe the state's procedures comply with [federal law]." CMS also wrote that California's legal arguments do "not align with the requirements of the statute and its implementing regulations." In other words, the State is not fulfilling its legal requirement to enforce hearing decisions and its legal arguments are wrong.

    That's what we've been telling the State for years.

    Enforcing orders requiring nursing homes to readmit illegally evicted residents is not only a lawful imperative, it is a moral imperative. The State shamefully continues to waste taxpayer dollars and state resources on fighting to maintain its rotten abandonment of dumped nursing homes residents. We hope that CMS's opinion will finally convince the State to do its job.

    click to read more
    (posted September 15, 2021)
  • New York Times Calls Out Resident Drugging Hidden by Phony Diagnoses
    New York Times story has called out the growing use of fake schizophrenia diagnoses in nursing homes.  These fake diagnoses conceal the drugging of residents from the public via a shoddy "quality measure" used in the CMS 5-star ratings system.  Incredibly, doctors are not making antipsychotic prescriptions to suit a diagnosis, they are making diagnoses to suit a prescription.

    The perverse incentives that drive this fantasy medicine are described in the story and have been a concern for several years.  Nonetheless, policymakers continue to do nothing and instead enable overdrugging by continuing to find thousands and thousands of instances of drug misuse to be "no harm."
    (posted September 13, 2021)
  • Long Term Care Facility Visitation Lockouts Due to COVID Outbreaks - Are They Legal?
    Despite the ongoing pandemic, in-person visitation is mandatory in California long term care facilities.  However, a number of facilities are shutting down all in-person visitation indefinitely when a staff member or resident tests positive for COVID-19.  Generally, these visitation lockouts are illegal.

    The only time a facility may temporarily shut down in-person visitation is when a local public health authority has directed that visitation be stopped or in nursing homes under very specific circumstances outlined by the Centers for Medicare and Medicaid Services.

    The current visitation rules in nursing homes and assisted living facilities are summarized here.  These rules apply, regardless of COVID outbreaks in a facility.

    If you or your loved one's facility is locking out visitors due to an outbreak, or for any other reason, ask the facility management what rules they are following that permit the lockout and provide the facility with CANHR's visitation summary.  If the facility persists in an unauthorized lockout, file a complaint with the state Department of Public Health and explain that the visitation lockout is an "immediate jeopardy" violation.  If CDPH is not able to restore visitation at the facility within 72 hours of your complaint, contact CANHR and let us know.
    (posted September 3, 2021)
  • Licensing by clerical error: How the state’s mistake decided the course of two nursing homes
    So reads the headline of a highly disturbing CalMatters article about the California Department of Public Health (CDPH) issuing licenses by mistake to a nursing home operator it has found in other instances to be unfit. The August 19, 2021 article involves two Los Angeles area nursing homes – Country Villa South Convalescent Center and Country Villa Los Feliz Nursing Center – that have histories of poor care and, according to a CalMatters analysis, are in the top 4 percent of nursing homes statewide with the highest numbers of resident deaths due to COVID-19. Making matters worse, CDPH reaffirmed the licenses after learning of its clerical error, demonstrating once again that it is in the grasp of the nursing home industry.
    (posted August 19, 2021)
  • Nursing Home Improvement and Accountability Act Introduced in U.S. Senate
    On August 11, Senator Ron Wyden, Chairman of the Senate Finance Committee, Senator Bob Casey, Chairman of the Senate Aging Committee, and several other senators introduced the Nursing Home Improvement and Accountability Act of 2021. The bill aims to increase transparency, accountability and oversight in nursing homes, improve staffing and support innovation in the structure and culture of nursing homes. Among its many provisions, it would require updated staffing studies to be conducted and used to set minimum staffing requirements, mandate a registered nurse to be present 24 hours a day, and ban use of pre-dispute arbitration agreements in nursing homes and related settings.

    CANHR supports this important legislation. You can learn more about it by reading the legislative text, a bill summary, and a section-by-section summary of the bill.
    (posted August 16, 2021)
  • New Vaccine Mandates
    As a new surge attributed to the Delta variant takes hold throughout the State, nursing home residents and their families may be relieved to hear that California has issued the nation’s first order requiring COVID-19 vaccinations for health care workers.

    The new order, issued August 5, mandates that employees of hospitals, nursing homes and other medical facilities have until September 30 to get their first dose of a one-dose regimen or their second dose of a two-dose regimen. The new rule permits exceptions only for religious reasons or for certain rare medical conditions.

    California also ordered visitors to hospitals, skilled nursing homes and facilities for the developmentally disabled to be fully vaccinated or show a negative COVID-19 test within 72 hours before each visit. The order applies only to indoor visits and took effect on August 11.
    (posted August 16, 2021)
  • The New and Much Improved Health and Safety Code Section 1418.8
    Health Care Decisionmaking for Unrepresented Nursing Home Residents in 2021 and Beyond
    Eight years after CANHR filed a lawsuit to challenge the constitutionality of Health and Safety Code Section 1418.8 (“Section 1418.8”), California finally has a better law for balancing the health care needs and rights of “unrepresented” nursing home residents. Unrepresented residents are those who have diminished decisionmaking capacity and lack a surrogate decisionmaker. For nearly thirty years, these residents were essentially at the mercy of nursing home staff members to decide what care they would receive or not receive, including the withdrawal of life sustaining treatment. 

    In 2019, a California appellate court ruled that Section 1418.8 had significant constitutional defects and required changes to protect residents from health care decisions that served the interests of nursing homes instead of their own. (CANHR v. Smith, 37 Cal.App.5th 814) Legislative efforts were deferred in 2020 because of the Covid-19 pandemic but moved quickly in 2021 thanks to Senator Pan’s Senate Bill 460, which was improved by the State Health and Human Services Agency and passed by the legislature in AB 135, a budget bill signed by the Governor on July 16. The signed bill represented the culmination of six months of extensive collaboration between Senator Pan’s office, the nursing home industry, CANHR, the Departments of Aging and Public Health, and many other stakeholders.

    The most pivotal piece of the legislation is the allocation of four million dollars to form a Long-Term Care Patient Representative Program. The program will be spearheaded by the Department of Aging, which will train, certify, and supervise public patient representatives throughout the state, likely provided by county or local non-profit agencies.

    The new Section 1418.8 includes the following key provisions:

    1. A patient representative, unaffiliated with the nursing home, must be part of the resident’s decisionmaking inter-disciplinary team (“IDT”). If there is no patient representative, the facility cannot proceed with its decisionmaking process.  (subsection (e)(1); also see subsection (c)) Public patient representatives will serve for residents who do not have a family member or friend to fill this role.

    2. No treatment decision requiring informed consent may be made by an IDT without the agreement of the patient representative. If the IDT members cannot reach consensus, the facility may not proceed with the proposed intervention unless it obtains a court order.  (subsection (i))

    3. Unrepresented residents must receive two separate written notices related to the IDT: the first to tell them an IDT meeting is going to be held and the second to tell them the results of the IDT meeting and their right to seek judicial review. (subsections (d) and (f))

    4. Nursing homes are required to report important data regarding decisionmaking for unrepresented residents to the Long-Term Care Patient Representative Program.


    The new law sets a deadline of July 1, 2022 for the patient representative program to be up and running.  In the meantime, nursing homes are not required to have patient representatives as part of their IDTs. However, facilities ARE required to provide written notices to unrepresented residents and provide copies of those notices to “a competent person whose interests are aligned with the resident” or to the local long term care Ombudsman program. Those requirements were ordered by an Alameda County Superior Court judge and have been in place since 2020. Download and read the court order HERE.

    click to read more
    (posted August 6, 2021)
  • Podcast: How to Advocate for a Loved One Labeled "A Bad Fit."
    CANHR Staff Attorney Tony Chicotel is featured on a new podcast from the National Consumer Voice for Quality Long-Term Care discussing long term care facility residents who are labeled "a bad fit." Residents and their advocates often feel shame and impotence about dementia-related behaviors and are hesitant to address the failures in care that cause such behaviors.  In the podcast, Tony talks about raising expectations for dementia care and exercising residents' rights to care that maximizes their comfort and quality of life.  The podcast is part of a series to help people pursue good long term care.
    (posted August 4, 2021)
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If you would like to invite CANHR to a support group meeting, resource fair, or other event in your community, please complete a speaker request form online.
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.