Crackdown Planned on Nursing Homes

SACRAMENTO —  Seizing on an issue dear to the elderly and aging baby boomers, Gov. Gray Davis on Monday will propose a series of get-tough sanctions for bad nursing homes, along with tax breaks and other steps to help people avoid going into long-term care facilities.

The Democratic governor is offering the sanctions only three months after vetoing legislation that contained many of the same provisions--a step that incurred the wrath of activists who work on behalf of the elderly.

Davis wants to spend more than $250 million in state and federal money for his proposals, which include $123 million in wage increases for workers who care for elderly people in their homes and in nursing homes.

He is calling for a 50% increase in the number of state Department of Health Services investigators who probe complaints at nursing homes, and would quadruple fines against nursing home operators when negligence or abuse leads to a patient’s death.

Davis also wants $500 tax credits for people who care for frail or elderly relatives who otherwise might end up in nursing homes--a plan he offered in his State of the State speech Wednesday. To gain maximum attention for his ideas, Davis’ aides have provided more details in anticipation of the Monday release of his proposed budget for the 2000-2001 fiscal year, which requires legislative approval.

The proposals were quickly lauded by advocates for improved nursing home care, including the American Assn. of Retired Persons--a group that represents a significant source of votes--and organized labor, long a cornerstone of Davis’ political support.

“I can’t believe it; it’s wonderful,” said Pat McGinnis, director of the nonprofit California Advocates for Nursing Home Reform in San Francisco. “Never in my wildest dreams would I ever think he’d be dealing with . . . all of these things that we’ve wanted for so long.”

Californians over age 85 represent the fastest growing segment of the state’s population. Adding to the power of the issue of nursing home quality, increasing numbers of baby boomers find themselves caring for parents and are themselves even beginning thinking about retirement.

Much of the angst is focused on California’s 1,425 nursing homes, which care for 250,000 people and where the main workers, called certified nurse assistants, are paid an average of $7.50 an hour.

The governor is proposing to increase the number of state Department of Health Services investigators assigned to look into problems and complaints at nursing homes to 386 from the current 253, at a cost of $15.4 million.

Fines for nursing homes where negligence or abuse leads to a patient’s death would quadruple, to $100,000. The state issued 23 citations last year that would have resulted in the maximum fines--although the state rarely collects the full amounts. Fines for far more common violations would double to $20,000.

Additionally, the health department would gain broader authority to seize nursing homes that are financially unsound or where care is chronically poor.

Among their duties, the added investigators would conduct unannounced nursing home inspections. Nursing home staff have acknowledged in interviews and court testimony that they typically knew about inspections days ahead of time.

In a focus group organized by the AARP last year in the Bay Area, nurse assistants said that when inspectors were expected to show up, more workers were called in to work, they were provided with extra supplies and told to provide better care.

The added investigators also would provide intensive review of homes that fail to meet minimum standards. And they would allow the health department to respond to complaints at nursing homes within 48 hours.

Currently, the state’s goal is to respond within 10 days, although the state did not attain that goal 35% of the time last year, said health department spokesman Ken August.

In October, Davis vetoed legislation by Assemblyman Kevin Shelley (D-San Francisco) that contained many of the provisions the governor now proposes. The veto prompted a massive telephone and mail protest by the AARP, said Tom Porter, the group’s state director.

“The politics of this are overwhelming,” Shelley said. “By moving forward in this policy area, you are addressing the needs of our parents, and you’re putting a down payment on the system for when we get there. It is something the electorate is thinking about. It’s huge.”

Besides the sanctions, Davis proposes to increase pay for nursing home workers by 5%, in addition to the 5% raise they are to receive as a result of last year’s budget.

“The 5% wage increase, for an industry that is so far below market rate, is going in the right direction, but is not nearly enough,” said lobbyist Beth Capell, whose clients include Service Employees International, which represents workers who care for the elderly and frail.

A spokeswoman for the nursing home industry also lauded the proposal to raise pay and training. “Anything we can do to improve the work force is good,” said Kelley Queale, spokeswoman for the California Assn. of Health Facilities.

However, Queale criticized the plan for omitting an increase to the basic rate that nursing homes receive for caring for frail and elderly people: $88 per patient per day. An estimated 11% of the state’s 1,425 nursing homes are in bankruptcy.

“We view the financial situation as being in a crisis,” Queale said.

The tax credit Davis proposes for people who care for elderly relatives at home would save Californians $47 million a year in income taxes, Davis’ Department of Finance estimates.

And the budget will include $55 million to boost wages of workers who provide in-home care to frail and elderly people--a 35-cent-an-hour raise to $6.60 an hour next year. To attract such workers, the state would attempt to draw on people currently on welfare, earmarking $35 million in federal money to provide them with training.

Medi-Cal, the state and federally funded health care insurance program for the poor, would be expanded to add about 13,000 people not currently covered.

“To hear a governor say we want to have people stay at home . . . that’s a wonderful message,” said Pat Luby, spokesman for the American Assn. of Retired Persons.