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California and the West

Davis Signs Bill to Tighten Oversight of Nursing Homes

Health: Law establishes steeper fines and tougher inspections. But activists say it ignores the key problem of too few workers.


SACRAMENTO — California nursing homes face steeper fines and closer inspection under a bill signed Thursday by Gov. Gray Davis, but critics say the new law doesn't fix the biggest problem in nursing homes these days: too few workers.

The new law, signed by the governor in San Francisco, does not force nursing homes to hire more workers. Nor does it change the flat-rate system California's Medi-Cal program uses to pay for nursing home care, a method that critics say encourages owners to skimp on care.

Instead, on those issues the new law, AB 1731 by Assemblyman Kevin Shelley (D-San Francisco), requires studies by the state Department of Health Services; recommendations are due next spring. Last year the governor drew heavy criticism from senior citizens by vetoing a bill that would have forced homes to hire more workers.

"There's a lot of good things in there in terms of enforcement, consumer information, residents' rights," said Pat McGinnis, executive director of the California Advocates for Nursing Home Reform in San Francisco. But, "how many studies do we need to know that we're understaffed?" she said.

Representatives of the nursing home industry acknowledge that a labor shortage hampers their ability to provide at least 3.2 hours of attention for each resident every day, the state minimum. About 120,000 nurses and nurses' aides now care for about 250,000 people in California nursing homes. An additional 30,000 workers are needed to accomplish that minimum care level, said Kelley Queale, communications director for the California Assn. of Health Facilities.

Beth Capell, lobbyist for the union representing about 20% of nursing home workers, called the new law a step forward but vowed: "We'll be back."

She said the primary reason California's nursing homes rate so poorly with the federal government--a 1998 report found that one-third of the state's homes had been cited for serious violations in the previous three years--is inadequate staffing.

"Today a single nurse's aide cares for as many as 35 patients at night and 10 to 14 on a day shift," said Capell, who represents the Service Employees International Union. "They all must be bathed, dressed, have their hair combed, teeth brushed, face washed, be fed breakfast and lunch and dinner. The reality is they don't always get through all that for all 14 patients. They can't do it."

Besides triggering studies, the new law quadruples to $100,000 the maximum fine against nursing homes found culpable in the death of a patient. It also gives patients the right to a hearing when nursing homes transfer them to hospitals and refuse to accept them back. The law makes it easier for the Department of Health Services to revoke an owner's license and forces state inspectors to check out serious complaints within 24 hours.

It also tries to reward good behavior with $8 million to be distributed, perhaps in the form of staff bonuses, to nursing homes deemed exemplary by the state.

"This really fills in some of the gaps that have existed in state law, and it will really give us a whole range of tools in terms of enforcement, resident protections and acknowledging quality," said Department of Health Services Deputy Director Brenda Klutz. The law takes effect in January.

Related legislation that the governor signed Thursday affects nursing homes that advertise special skills in caring for Alzheimer's disease and dementia patients. The bill, AB 1753 by Assemblywoman Gloria Romero (D-Los Angeles), mandates at least six hours of targeted training for workers each year.

Shelley set out to tighten oversight of California's 1,450 nursing homes after trying to find care for his mother. The new law falls in line with the governor's "aging with dignity" campaign, aimed at helping people older than 85, the fastest-growing segment of the state's population.

Acknowledging that low wages exacerbate high nursing home worker turnover--the average pay is about $7 an hour--the governor and Legislature last year boosted funding provided by Medi-Cal, the state program that pays for nursing home care for indigent people, to give workers a 5% raise. Medi-Cal covers about 65% of nursing home residents.

Many workers complained that they didn't get a raise. There have been fewer complaints this year about nursing homes passing along a second, 7.5% wage increase included in the most recent budget. That budget also included money to double the number of state nursing home inspectors to 400 and increase Medi-Cal payments to nursing homes by 11%.

Queale said that last year many nursing homes simply held on to the money for the 5% raises until they could get better direction on how to use it. The Department of Health Services is now auditing nursing homes where workers complained they were cheated of raises.

The new law also eliminated a requirement that the department notify the news media when nursing homes are cited for abuse. Klutz said the requirement was never consistently followed anyway. The department, she said, intends to establish an Internet site by January 2002 to open public access to citations against nursing homes. In the meantime, Klutz said, consumers can call the department's various district offices to get such information.

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