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State, L.A. Near Deal To Boost Nursing Home Inspections

The Los Angeles County Department of Public Health could receive nearly $15 million in additional state funds and about 70 more staff members under a proposed new contract with the state to expand and increase oversight of nursing homes.

But a yearlong training and certification process for new staff members means that the longstanding backlog of nursing home investigations could get worse before it gets better.

“It is not a quick fix,” said Cynthia Harding, interim director of the county public health department. “It is going to take some time to fix the chronic understaffing and underfunding.”

The proposed changes come after several audits, state reports, legislative hearings and news articles documented poor oversight and lengthy delays in nursing home investigations by both the county and state public health departments. As a result, nursing home residents and their families waited months or even years for complaints to be resolved and for the facilities to be penalized. Los Angeles County contracts with the state and federal government to oversee health and safety for nursing home residents at about 1,300 facilities countywide.

In addition to the increased funding, the proposed contract also gives the state responsibility for licensing all new nursing facilities, according to the county. L.A. County would continue to conduct routine surveys of nursing homes and investigate complaints, prioritizing those involving alleged violations that may have caused injury or death to a resident. Harding said the county will close investigations of all such serious complaints, known as immediate jeopardy cases, and will “work very hard” to close the others.

The L.A. County Board of Supervisors is expected to vote on the proposal Tuesday before it goes to the state for approval. The state Department of Public Health declined to comment until the contract is approved. The three-year contract would begin July 1.

Harding said her agency has re-trained its employees, assigned new management, clarified policies and improved data collection. But she said the department could do only so much with a shortage of employees.

There were 2,731 open complaints in Los Angeles County as of March 31, according to the state Department of Public Health. The county took 352 days on average to finish cases — about 100 days longer than the state.

“The main thing that we couldn’t fix, at the end of the day, was the staffing,” Harding said. “Corners were cut and mistakes were made.”

The county has repeatedly argued to the state that the funding of the licensing and certification division was not sufficient to meet the workload, and that the department needed more than 300 employees to handle investigations on all health care facilities.

L.A. County has also argued that it was responsible for one-third of the state’s facilities but only received 15% of the state funding allocation. But one audit found that L.A. County did not use all the funds it received.

With the additional staff, bringing the total to 224, Harding said the agency will be able to do a “better job protecting the vulnerable populations in these facilities.”

She also said the county is working with the state and federal government to see if there is a way to streamline the yearlong training process.

Advocates are less confident that the increased funding and staffing will improve care for nursing home residents in Los Angeles County.

“The state shouldn’t give the county any new money until they have accountability measures in place,” said Michael Connors, an advocate with California Advocates for Nursing Home Reform. “We haven’t seen any signs that things are getting better.”

Connors said there are still problems with incomplete investigations and slow response to complaints.

The long-term care ombudsman in L.A. County, Molly Davies, said she is pleased the county will get an infusion of funds that they clearly need. And she is hopeful it will result in more oversight of nursing home care. But Davies said the county needs to do much more than add funds.

“I don’t think you can throw money at an organization and have business as usual,” said Davies of WISE & Healthy Aging. “They need to restore the public’s confidence in them and that takes more than doing things the way you have always done them.”

Blue Shield of California Foundation helps fund KHN coverage in California.

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