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⭒ News & Notes Archive

November / December 2020

In this Issue


CANHR Participating in the Community Advisory Vaccine Committee

CANHR has been asked to serve on the Community Advisory Vaccine Committee in its efforts to ensure the #COVID19 vaccine implementation is guided by the need for vaccine safety, equitable distribution, and transparency. Learn more HERE. Long term care residents and family members with concerns about vaccine distribution should reach out to us.
 


Can Long Term Care Facility Residents Go Home for the Holidays During the Pandemic?

While recognizing they have a right to do so, public authorities are recommending that residents not leave facilities to gather together with loved ones during the public health emergency. In recent weeks, the Centers for Medicare and Medicaid Services (CMS), the California Department of Public Health (CDPH) and the California Department of Social Services (CDSS) have all issued alerts discouraging residents from participating in in-person family gatherings during the holidays.
 
What happens to those who leave? Authorities are urging them to minimize risks and are recommending various precautions to limit exposure to the virus. Although residents have the right to return following a holiday gathering, authorities have directed nursing homes and assisted living facilities to screen

and monitor residents carefully, to test them when indicated, and, when appropriate, to quarantine returning residents for 14 days. CANHR recommends residents and their representatives speak to facility management – in advance – about any plans they have for holiday outings and seek information, preferably in writing, about the facility’s protocols for returning to the facility.

On November 19, the Center for Medicare Advocacy updated its annual alert – Home for the Holidays: Leaving the Nursing Home During a Medicare-Covered Stay – to address the recent CMS guidance to residents, families and facilities on family holiday gatherings during the pandemic.

Read the November 18, 2020 CMS alert to Nursing Home Residents and Their Families on Holiday Gathering and Outings.

Read the November 20, 2020 CDPH All Facility Letter 20-86.1 to Long Term Care Facilities on COVID-19 Infection Control Recommendations during Holiday Celebrations

Read the November 20, 2020 CDSS Provider Information Notice 20-42-ASC on COVID-19 Infection Control Guidance for Celebrations and Outings
 


New Income Limit for the Medi-Cal
Aged and Disabled Federal Poverty Level Program
Effective December 1st

Effective December 1, 2020 the income disregard for the Aged, Blind & Disabled Federal Poverty Level Program (ABD FPL) has increased to 138% of the Federal Poverty Level. The new threshold is  $1,468 for a single individual and $1,983 for a couple in 2020. As of August 1, 2020 counties will no longer use the standard disregard of $230.00 for an individual or $310.00 for a couple when evaluating eligibility. All applicable program deductions such as the $20 any income, health insurance premiums and $65.00 and one half earned income deductions still apply. Impacted beneficiaries will have their eligibility recalculated in December 2020. For example, individuals who were previously paying a share of cost under the medically needy program or paying a premium under the 250% working disabled program will be reevaluated under the new threshold. For more information see the ACWDL 20-04 and MEDIL 20-29.


California Department of Public Health Moving Forward with Divisive Plan to Turn Inspectors into Consultants to Nursing Home Operators

On November 20, 2020, the California Department of Public Health (CDPH) wrote CANHR rejecting CANHR’s call to withdraw its misguided plan to turn nursing home inspectors into consultants to nursing homes. After spending the summer touting the benefits of a consultative role for inspectors, CDPH now disingenuously claims that its new survey model will not be consultative. Its actual plan and revised duty statement for inspectors show otherwise. The highly controversial duty statement is the subject of an Unfair Practice Charge filed on August 28 by SEIU Local 1000, the union representing RN inspectors, against CDPH.
 


Associated Press Article Describes a Wave of Deaths from Neglect in Nursing Homes During the Pandemic

In addition to the over 90,000 reported deaths due to COVID-19 in the nation’s nursing homes since March, the Associated Press is reporting findings that more than 40,000 additional residents died prematurely due to other causes. Those “excess deaths” were identified through an analysis conducted by Stephen Kaye, a professor at the Institute on Health and Aging at the University of California, San Francisco. The November 18 AP article – Not just COVID: Nursing home neglect deaths surge in shadows – describes a tandem wave of horrific deaths in nursing homes due to extreme neglect and isolation. The analysis found that for every two COVID-19 victims in nursing homes, there is another who died prematurely of other causes.
 
California officials have turned a blind eye toward this wave of deadly neglect by suspending regular inspections that evaluate the quality of care in nursing homes. The federal Centers for Medicare and Medicaid Services (CMS) gave the California Department of Public Health (CDPH) authority to restore full inspections more than three months ago, yet it still hasn’t done so, opting instead to divert inspectors to narrowly focused infection control surveys that its own inspectors have harshly criticized for ignoring neglect. Alarmingly, CDPH’s actions are helping to cover up neglect rather than to detect and stop it.
 
Not surprisingly, the AP’s investigation points to understaffing as a primary cause of the neglect. Here too, the CDPH is aiding negligent nursing home operators and exposing residents to neglect by rubber-stamping hundreds of operators’ requests to waive California’s minimum staffing standards during the pandemic. CDPH has granted such waivers to over 300 skilled nursing facilities, including to some of the worst performing nursing homes in the state.
 


New Study Examines COVID-19 Cases and Deaths in California’s Nursing Homes

On December 1, the California Health Care Foundation released a new report – COVID-19 in California’s Nursing Homes: Factors Associated with Cases and Deaths – that was prepared by a team of researchers from UCSF, Cal Hospital Compare and IBM Watson Health. Early in the pandemic, the study found that low staffing levels and for-profit ownership were major factors triggering outbreaks and deaths in California nursing homes. For-profit nursing homes had COVID-19 case rates five to six times higher than those of nonprofit and government-run nursing homes while facilities with RN staffing greater than 0.8 hours per resident day had 50 percent fewer COVID cases than nursing homes that staffed below that level. As the pandemic spread, demographic factors including age and race were found to be significant risk factors. For example, nursing homes with higher percentages of Latino residents were found to have larger outbreaks than those with smaller populations of Latino residents. The report contains a series of important recommendations on staffing, ownership oversight, health equity promotion, facility size and design, transparency and public reporting of data.
 
Read the Los Angeles Times article on the report: As virus again surges in California, race is a defining factor in nursing facilities, research shows
Read the San Francisco Chronicle article on the report: Coronavirus cases and deaths soared in nursing homes across California. Here’s why.
 


Nursing Home Complaints Undermined by CDPH Website Change

What happened? Due to a change in the way CDPH formats its on-line complaint form, people who file complaints against health facilities, including nursing homes, no longer see fields in which they can input their contact information. Therefore, complaints are being received as anonymous.

What can I do? If you have filed a complaint in 2020 and have not received a letter officially opening the investigation, re-file your complaint asap.

Can I still file complaints on-line? Yes, just be sure to enter your (the complainant’s) information in the “complainant information (optional)” box on the complaint website – unless of course you wish to remain anonymous. To file a complaint, go to
https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/Complaint.aspx
and enter the facility name. To open the complainant information input fields, click on the arrow in the “complainant information (optional)” box. A picture of the box is below.

Los Angeles Times Reports L.A. County is Epicenter of Hospice Fraud and Abuse

On December 9, the Los Angeles Times published a remarkable set of articles describing alarming growth of for-profit hospices in Los Angeles County and California that are engaging in what the Times described as “audacious, widespread fraud in an industry meant to provide comforting care” to those who are dying. In Los Angeles County, the number of hospices has multiplied sixfold during the last decade and now is home to over 600 agencies, the highest concentration of hospices in the nation. The cities of Burbank, Glendale and Van Nuys each have more hospices than the entire states of New York, Florida, and many others. Virtually all of the explosive growth has involved for-profit operators. In Los Angeles County, 97% of hospices are for-profit.
 
Rampant fraud and abuse have accompanied the explosive growth. The Times investigation found hundreds of instances in which California hospice patients were harmed, neglected or put at serious risk. According to the Times, quality of care failures ran the gamut from mismanaged medications to neglected wounds that became infested with maggots. In some cases, nurses and home health aides repeatedly missed appointments or slept on the job as patients lay writhing in pain. Pointing out the need for reform, the Times reported that those responsible for fraud, abuse and neglect rarely suffer any consequences due to extremely poor oversight and the almost complete absence of any penalties.
 
Read the articles:

Dying Californians suffer harm and neglect from an industry meant to comfort them

End-of-life care has boomed in California. So has fraud targeting older Americans

What you need to know if you or a loved one requires end-of-life care