County Approves Care-Home Reforms

This article first appeared in U-T San Diego.

San Diego County officials launched an effort to protect residents of assisted living centers on Tuesday, increasing oversight staff, focusing prosecutions and partnering to offer more site-specific information for consumers.

County supervisors agreed to double the staff in their Long-Term Care Ombudsman program to eight full-time positions, reversing cuts approved five years ago.

They also began work with the Better Business Bureau to create a rating system for assisted living homes so families will have more confidence in the decisions they make for their elderly relatives.

District Attorney Bonnie Dumanis announced a pilot project dedicated to prosecuting crimes inside assisted living homes — neglect and abuse incidents that regularly go unpunished by state investigators.

“While many assisted living homes and skilled nursing facilities do right by our elderly, others are a source of shame,” Supervisor Dianne Jacob said in announcing the series of local reforms. “Watchdog reports in U-T San Diego and other media outlets have documented deeply disturbing gaps in treatment and supervision at some facilities that have led to serious illness and even death. The conditions at some homes are deplorable.”

The U-T’s “Deadly Neglect” series in September and December, a partnership with the CHCF Center for Health Reporting, identified at least 27 deaths due to abuse or neglect at local assisted living homes in recent years.

Scores of other residents were sickened by medication errors and other deficiencies, the reports showed, and the state police force charged with investigating crimes inside the homes has not made an arrest since 2004.

Under California law, the heftiest state fine regulators can impose is $150, even when a resident is killed as a result of a violation.

County supervisors also voted to support the RCFE Reform Act of 2014, a series of bills introduced in January by bipartisan lawmakers incensed at findings in the U-T and other media outlets. RCFE is the state acronym for the homes, known as residential care facilities for the elderly.

Among other things, the reform bills would boost fines for violations, require more-frequent inspections of homes, speed up the time it takes to investigate complaints and require licensees to buy liability insurance.

The bills are making their way through the statehouse, with a key set of hearings set for early next month.

Meanwhile, the county board action on Tuesday directs top administrators to work with home operators and the Better Business Bureau to develop a grading system that rates specific homes based on past compliance with state regulations.

A budget and update on that project is due by the end of this year.

Dumanis introduced a program aimed at prosecuting abuse and neglect cases from inside senior homes, and a media campaign to raise awareness of abuse and neglect issues.

The effort begins with $190,000 in current-year sales-tax revenue earmarked for public safety projects. In July, $1.3 million of those funds will help prosecutors boost enforcement of standards of care and improve their review and follow-up work on incident reports and criminal referrals.

“Our goal is to obtain permanent funding to keep up these efforts for years to come,” Dumanis said.

The District Attorney’s Office already maintains an elder-abuse unit, but the attorney in charge of that office has complained that state regulators rarely refer cases to his staff.

“The unit will have dedicated staff members to carry out this work, which of course, will take time to pull together,” Dumanis added. “The employees will come from within our ranks — they will not be new hires.”

The Board of Supervisors hearing Tuesday drew several consumer groups intent on pressuring elected officials to do a better job overseeing board and care homes.

“We know that crimes specifically committed in RCFEs are rarely referred” to prosecutors, said Chris Murphy of the Consumer Advocates for RCFE Reform nonprofit group. “Community Care Licensing and its internal investigations bureau stifle investigations after agency involvement.”

Aaron Byzak, who formed the Hazel’s Army advocacy group after his grandmother died from complications due to neglect at an Oceanside assisted living home, told supervisors the home was fined just $150.

“If they had illegally parked in my grandmother’s disabled parking space, the fine would have been $250,” he said.

Gloria Harris, a county mental health board volunteer, complained to supervisors that there is no requirement for state licensees to post a residents’ bill of rights inside the facilities.

“Most residents don’t even know what an ombudsman is,” she said.

More than 170,000 people in San Diego County are 75 or older, a number that is expected to nearly double by 2030, Jacob said in introducing her reform proposals.

The primary responsibility for regulating assisted living homes and skilled nursing facilities lies with the state, Jacob said, but the county should improve its areas of responsibility.

“The county, as the region’s lead public health agency, must also do all it can to safeguard our elderly,” she said. “Especially with the silver tsunami coming.”

Not everyone is convinced regulations will improve living conditions inside assisted living facilities.

Warren Hooper, a retired rancher who lives in an El Cajon skilled nursing center, contacted U-T Watchdog this week after reading a Sunday report about the state’s failure to investigate complaints inside a Vista home.

Hooper, 78, said inspectors tend to rely on reports written by staff rather than eyewitness complaints from residents.

“They told me they have to believe whatever these people write down as truth,” he said. “So I don’t know how you enforce (new rules) unless you have a cop on the corner directing traffic, and they don’t have that.”

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