August 14 was a milestone day in the year-long effort to reform Residential Care Facilities for the Elderly (RCFE) in California. After months of grassroots energizing, amendments, and endless committee debate, the bulk of RCFE Reform Act bills faced their final committee votes. After the votes were taken and the dust had cleared, the bills aimed at the facilities had all moved forward. The bills aimed at better state oversight had all died. This was not a coincidence.
The thirteen bills that made up the RCFE Reform Act of 2014 were introduced by a bipartisan group of legislators following multiple media reports that revealed widespread abuse and neglect of residents and poor state oversight by the Department of Social Services (DSS). Some of the bills aimed at improving care in facilities: new training requirements for staff, increased penalties for poor care, and creating a resident bill of rights. Other bills moved to enhance RCFE supervision by DSS: mandating annual inspections, enhancing investigations of consumer complaints, and creating an on-line information system so the public could compare facilities. Both approaches were considered necessary to improve the lives of RCFE residents.
When the bills imposing DSS changes failed in their final legislative committee test on August 14, the state message regarding RCFE Reform became clear: facilities will be held accountable, DSS will not be. The legislature has given cover to what appears to be DSS intransigence.
RCFE Reform is notably incomplete without significant changes to DSS oversight. The tragedies widely reported by the media last year were enabled by failures in state supervision that will now go uncorrected by the legislature. As RCFE reform limps to the finish line, 174,000 residents of RCFEs are left wondering when the state is going to figure out that it is both part of the problem and a critical part of the solution.