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⭒ News & Notes Archive

October / November 2020

In this Issue

Income Limit Increases for Aged, Blind and Disabled – Effective December 1st

Implementation of the increased income ceilings for the Aged, Blind and Disabled Federal Poverty Level program will become effective December 1, 2020. Once implemented, the change will eliminate a share of cost for thousands of aged and disabled beneficiaries on Medi-Cal by significantly increasing the income threshold for qualifying without incurring a share-of-cost. Currently, the countable monthly income ceilings for this program are $1,294 for a single person and $1,747 for a couple. Under the 138% FPL the income level for a single individual will be $1,468 – a significant increase – and for a couple, the income limit will be  $1,983.
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Los Angeles County Inspector General Issues First Report on Nursing Home Investigation

On October 14, the Inspector General appointed to investigate the crisis in Los Angeles County nursing homes released the first interim installment of what will be a multi-part report. Even this first report makes it clear that the County’s Department of Public Health, which contracts with the State to provide oversight and inspection of Los Angeles facilities, has badly failed the County’s long term care residents.

The report states that almost half of the 5,407 current nursing home complaints concerning County residents have remained open for over three years, and that 547 investigations involving residents in immediate jeopardy are unresolved. The report also raises questions regarding the County DPH’s designation of dozens of poorly performing nursing homes as facilities dedicated to COVID treatment. While the initial report draws needed attention to the County’s dysfunctional oversight, it remains to be seen if the continuing investigation will identify and address the horrific conditions that have endangered nursing home residents in the County for decades.

CANHR Fights California Department of Public Health Plan to Transform Nursing Home Inspectors into Advisors to Operators

On October 5, CANHR wrote the California Department of Public Health (CDPH) urging it to withdraw its deceptively named nursing home oversight plan – Quality and Safety State SNF Survey Model – that would divert its inspector workforce by requiring inspectors to conduct collaborative monitoring visits at skilled nursing facilities. CANHR’s letter also urges CDPH to rescind a new duty statement for nursing home inspectors that requires inspectors to spend 30 percent of their time advising and assisting nursing home operators on regulatory matters. 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.

Office of Inspector General Reports States Are Still Not Investigating Nursing Home Complaints in a Timely Manner

The latest in a long line of investigations on failed oversight of nursing homes found that many states are consistently failing to meet federal performance standards for investigating high priority complaints. The findings are detailed in a September 2020 report by the federal HHS Office of Inspector General: States Continued to Fall Short in Meeting Required Timeframes for Investigating Nursing Home Complaints: 2016-2018.

KPBS Reviews Abuse and Big Profits in El Cajon Nursing Home

A recent two-part series from KPBS examined abuse, poor care, and big profits at Avocado Post Acute, a nursing home in El Cajon. The first story focused on an alleged sexual assault perpetrated by a certified nursing assistant (CNA) against a resident. The resident reported the incident to multiple staff members within hours after it happened but the facility management did not respond timely or appropriately. The CNA accused of the assault was initially permitted to return to work and may have committed sexual misconduct at different nursing homes before and after the alleged incident at Avocado Post Acute. The second story reported that Avocado has a very poor track record for regulatory compliance and has significantly understaffed its facility, causing harm to residents while reaping big profits for the owners.

For the alleged sexual assault and failure to appropriately report the allegations to the authorities, Avocado Post Acute received two minor federal deficiencies deemed “no harm.” No state citation was issued despite a law making the failure to report alleged abuse within 24 hours an automatic Class B citation.

As Pandemic Raged and Thousands Died, Government Regulators Cleared Most Nursing Homes of Infection-Control Violations

So said the headline of a remarkable Washington Post investigation report published on October 29, which revealed that about 43,000 residents died and 290,000 became infected with the coronavirus in nursing homes that received a clean bill of health from government inspectors. Despite promises of strong enforcement by the federal Centers for Medicare and Medicaid Services (CMS), inspectors cleared nearly 80 percent of nursing homes of any infection control violations even as the deadliest pandemic to strike the nation in a century sickened and killed thousands. Many of the nursing homes that were cleared had mounting coronavirus outbreaks before or during inspections. Several California nursing home inspectors told the Post that the Department of Public Health (DPH) directed them to counsel nursing homes rather than cite them for infractions. As CANHR has reported, DPH acknowledged this directive to CANHR and is seeking to institutionalize the transformation of inspectors into advisors to nursing home operators.

KQED Reports Long Term Care Facilities Lack Plans to Evacuate Residents Safely During the Pandemic 

On October 30, KQED aired a special 30-minute report examining the plight of Sonoma County long term care facility residents who were evacuated due to wildfires in recent weeks. The report –  When Wildfire Breaks Out During a Pandemic, Who’s Responsible for Elderly Evacuees? – describes hundreds of evacuees from long term care facilities being bused from congregate shelter to shelter during the middle of the night in late September because their facilities did not have functional evacuation plans. It points fingers at facility operators for poor emergency planning and at state regulators, who found no fault with the evacuations. 

Nursing Home Lobbyist Cries Poverty to Legislature While California-Based Nursing Home Chain Reports Record Profits

An Assembly Budget Subcommittee held an oversight hearing on October 28 on COVID-19 in Skilled Nursing Facilities that examined what California should do to help save lives of residents and staff in skilled nursing facilities. Some of the witnesses called for major reforms, such as safe staffing levels and living wages for caregivers. Craig Cornett, the President of the California Association of Health Facilities (CAHF), a nursing home lobby group, testified that the state needs to increase rates to nursing facilities because their profit margins are extremely low.

On the same day as the hearing, The Ensign Group – a nursing home chain headquartered in California – announced record earnings for the third quarter of 2020 in a report aimed at investors. It touted a nearly 100 percent increase in earnings over the prior year quarter and other financial highlights that it described as “record-breaking results.” 

Nursing Home Residents Describe Devastating Impact of Isolation During the Pandemic in New Report

An October 2020 report by Altarum presents the findings of a survey of residents on how their lives have been impacted by the Covid-19 restrictions. Residents reported a drastic reduction in social activities and a steep increase in feelings of loneliness. The report – Experiences of Nursing Home Residents During the Pandemic – includes direct comments from residents in their own words that speak powerfully to the urgent need to end the extreme isolation that’s been imposed on them.

CANHR COVID-19 News & Resources

If you have not already done so, please check out CANHR’s COVID-19 website. The rapidly evolving website has hundreds of pages devoted to COVID-19 information, news and resources related to long term care. It contains CANHR alerts and recommendations, information on visitation rights, state and federal directives, links to outbreak data, media stories, webinar recordings and much more. Also visit our Visitation Saves Lives website.