SACRAMENTO -- — California nursing homes bolstered their bottom lines with much of the $590 million that state lawmakers provided them to better tend to the poor, while patient care declined by several key measures, according to a study to be released today.
A law boosting reimbursements from Medi-Cal, the state's healthcare program for the poor, passed in 2004. By 2006, the first full year the higher rates were in place, average nursing home revenues from Medi-Cal had increased from $124 a day to $152 per day, according to the study by a team of researchers at UC San Francisco -- but few of the promised improvements for patients or staff had come to pass.
Nursing attention for patients grew, on average, by 3%. But the study also found that 144 homes, or 16%, did not meet the state's minimum staffing standard.
The average wage for nursing assistants increased from $10.61 an hour to $11.32, not quite enough to keep pace with inflation, the study said. And turnover among nurses increased slightly, with nearly 7 in 10 leaving their jobs that year.
The amount nursing homes spent on direct patient care actually decreased by 3.6%, according to the study. And substantiated complaints of patient mistreatment increased by 38%. State and federal regulators cited homes for 6% more violations.
"They got so much money, they should have been able to do something," said the study's lead author, Charlene Harrington, a UCSF professor and nationally recognized authority on nursing homes.
"The fact that they let the nursing assistant wages actually decline with inflation, I think there's no excuse for that," Harrington said. "They're the bulk of the workers and they're the lowest-paid."
The higher reimbursement rates were pushed through the Legislature in the final two weeks of its 2004 session by a powerful alliance between the nursing home industry and Service Employees International Union, which represents many healthcare workers. Several nursing home advocates objected at the time that the measure lacked sufficient safeguards to ensure that the money went to patient care.
Along with more money, the new law changed the way facilities were reimbursed: from a flat fee for each patient to one based on how much homes spent on workers, patients and facilities. Supporters pledged that the change would reward homes that hired more nurses and paid them better.
