"Editorial: Nursing–home patients shortchanged"
The San Francisco Examiner
SAN FRANCISCO – With California’s aged population growing rapidly, it is a safe bet that either you or someone close to you will spend time in a nursing home. And we should expect no less than proper, professional care from these Medi–Cal–subsidized, state–licensed facilities.
In 2004, when state tax revenues were still rosy, well–meaning legislators approved $590 million for a five–year increase in Medi–Cal reimbursements to nursing–home operators — a boost that was supposed to improve care for the poor and reduce what had been a trend of nursing homes going out of business.
The audit is now in for 2006, the first full year of higher payments, and the results are being described as somewhere between "mixed" and "appalling."
A research team from UCSF found that average nursing–home revenues from Medi–Cal patients increased from $124 to $152 per day. The average nursing home netted $248,047 in 2006, a hefty 233 percent increase since 2004. There were fewer facility closures.
So what humane improvements for patients and staff did this cash influx deliver? Well, substantiated patient complaints of mistreatment jumped 38 percent. State and federal regulators cited 6 percent more violations. And spending for direct patient care dropped 3.6 percent.
Minimum state staffing levels were not met at 16 percent of the nursing homes; 88 percent failed to comply with annual federal inspection regulations; and 22 percent had violations causing harm and jeopardy to patients.
Turnover among registered nurses increased in 2006, with nearly seven in 10 leaving their jobs even though their pay climbed 9 percent. Average hourly wages for nursing assistants — who provide the most patient care and are lowest–paid — increased from $10.61 to $11.32, which was not quite enough to keep up with inflation. On the other hand, administrators’ wages rose by 13 percent.
The higher Medi–Cal reimbursement rate was sped through the Legislature by a powerful alliance between the nursing–home industry and Service Employees International Union. The law also tied reimbursement to how much a nursing home spent on patients, workers and the physical plant. This change from flat fees was supposed to promote hiring more nurses and paying them better. But some nursing–home patient advocates objected that the bill lacked strong enough safeguards to ensure that money was actually spent on patient care.
The nursing–home industry’s response is that the audit was premature because higher reimbursement payments did not fully arrive until after an 18– to 24–month delay, which stoked fears that Sacramento might withhold pledged money — as it has done in the past.
Still, not enough is known about where the money went. And few of the promised benefits for California’s neediest nursing–home residents have surfaced, which is shameful. The law should be amended to give it much stronger teeth.