Given the ongoing scandal of poor care in many nursing homes across the country, culminating in approximately 200,000 deaths in the early stages of COVID, there were high hopes that the federal government would step in to help.

But Friday is the highly anticipated Biden

a

The government’s proposal to set minimum staffing requirements, while a step in the right direction, left much to be desired.

Advocates for the more than 1 million elderly and disabled patients in nursing homes wanted a much greater strengthening of the current relationship between nurses and patients. Meanwhile, industry representatives complained that the new demands have not been funded, even as low wages make it difficult to recruit and retain workers.

The two sides are likely to go to war during an upcoming public review of the proposal.

that would be implemented

nationwide over a three-year period. And as that happens, rest assured that more patients will suffer from negligent care. It has always been that way, given the level of disdain for the elderly and disabled in American society.

Tony Chicotel, senior staff attorney for California Advocates for Nursing Home Reform, has credited Biden with fulfilling his 2022 State of the Union pledge to address deficiencies that put patients at risk. But his praise came with a few caveats.

I think it’s a big deal and a positive step forward for residents, Chicotel said, citing the proposals’ higher nurse-to-patient ratios and a 24/7 requirement for RNs to be on site. But Biden wanted to ensure safety and quality of care, and I don’t think these numbers guarantee safety and quality of care. I think they should be higher.

And that’s only part of the problem. Another glaring shortcoming is the lamentable lack of federal and state oversight.

talked about,

Chicotel has been working on an article for its agency’s fall newsletter, telling the story of Sam Rios, an 87-year-old former college professor who died after developing pressure sores during a two-week stay at a Roseville nursing home in 2017. Chicotel writes that a nurse in the institution tested that the care there was barbaric.’

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Earlier this year, a jury in a civil case of elder abuse, negligence, underemployment and wrongful death awarded $30.9 million to the Rios family. But the Department of Health’s investigation found no violations by the nursing home.

The contradiction is staggering, writes Chicotel in its newsletter account, which bears an ominous headline:

Has California Nursing Home Oversight Ever Been Worse?

Chicotel told me there have been marginal improvements

in some areas of supervision

during the past years. And some facilities offer a much higher quality of care than others. But understaffing, overdue facility inspections and delays in complaint investigations continue to take their toll.

This means that enforcement action is often infrequent and weak, investigations are delayed, and operators with a poor track record can buy and operate more facilities, even after having been denied licenses in the past due to an extensive record of poor care and regulations. non-compliance, writes Chicotel for the newsletter.

CalMatters provided a good example of Chicotel’s latest point at the end of June:

The state is advancing, the news agency reported, with the licensing of twenty nursing homes whose key owners have long-established companies with problems, as revealed by a Calmatters investigation, despite a new law designed to provide better oversight.

This nursing home had the deadliest coronavirus outbreak in California. We were not prepared

Why would such an owner be allowed to stay in business? First, Chicotel says, there is a fear among state officials that patients will have nowhere to go if the facilities are closed.

And then there is the gradual shift towards de-institutionalization. Nursing homes are expensive, they cost taxpayers billions through Medicare and Medicaid payouts, and there is a growing preference among patients to age at home.

But it’s also not like we’ve mastered that aspect of elder care, with labor shortages and people going bankrupt paying for home care that isn’t covered by insurance.

Back to nursing homes,

In California, the state oversees nursing homes in all counties except one in Los Angeles. When COVID

covid

Through the gates of the province’s nursing homes, thousands of patients were trapped in what would later become death chambers. At the end of 2021, 19,401 residents and 16,656 employees had tested positive for COVID. The death toll included 3,506 residents and 115 personnel.

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Those numbers don’t get any less horrifying with the passage of time,

and the . It

That wouldn’t have happened if it wasn’t for a bunch of old people.

Shame on us.

In the aftermath of the massacre, the The

The provincial council of supervisors has ordered this

the

The Office of the Inspector General set out to investigate the facilities and provincial oversight of them, and the result was a damning report filed in October 2021.

The report cited inappropriate antecedents of documents, by provincial employees,

even if more employees; meanwhile, inspectors from the provincial health department

complained that he was under-trained, overworked and pressured to rush or close investigations prematurely.

The report

spelled overrepresented

39 reform recommendations, including tougher enforcement against the purchase and operation of facilities by owners with shady credentials, some of whom use affiliate networks to cover up financial transactions. It also recommended independent investigations into cases of elder abuse and improper record-keeping, along with other potential misconduct or systemic failings.

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Almost two years later, patient advocates wonder what has become of the recommendations.

Molly Davies, president and CEO of Wise & Healthy Aging, helped write part of the report in conjunction with the Inspector General. She said that to her knowledge only a few of the recommendations had been implemented

by the province.

If there was a report identifying widespread deficiencies in the Sheriff’s Department, Davies said, there would have been a few more public hearings.

I contacted County Supervisor Kathryn Barger, who sent me several reports from the Department of Public Health, most recently in May. Department Head Barbara Ferrer’s reports state that the majority of improvements have been implemented or are in the final stages. implementation, and that the board would be kept informed.

This was news to Davies, whose nonprofit runs LA County’s Long-term Care Ombudsman program, which means its staff investigates complaints from patients, their loved ones, and nursing home employees (the latter group, incidentally, is responsible for most complaints).

As far as Davies can tell from her team’s investigations and unannounced visits to nursing homes, there are systemic problems

are unbridled.

So when I shared the documents I got from Barger, Davies

said exactly what I thought

:

she had this to say:

Whatever happened happened behind the scenes, and there’s no accountability whatsoever.”

Davies said. So what’s the point?

Given what we’re talking about here, the health and well-being of the weakest and often the most helpless among us, there’s simply no excuse for not divulging every detail of what’s wrong and how to fix it.

Personally, I’m not happy with the way skilled nursing facilities operate, Barger told me. She said she believes licensing, nurse-to-patient ratios and patient care reimbursements should all be looked at by the county and state.

She said she would like to explore whether a public hearing could be scheduled to track progress on recommendations and reforms.

The sooner the better, and I’ll keep an eye on it.

In the meantime, if you are an employee, patient, or loved one with a concern about care, you can get help at CANHR.org, (800) 474-1116, or visit the Wise & Healthy Aging Ombudsman page at wiseombudsman.org , or call (800) 334-9473 during business hours or (800) 231-4024 outside business hours.

You can also drop me a line here at Golden State where I discuss the blessings and many burdens of aging.

[email protected]