The Schwarzenegger administration has proposed hiring scores of new regulators to conduct surprise audits of nursing homes after a California Watch investigation found some troubled homes had trimmed their staffs below the minimum number required by law.
Flickr photo by ulrichkarljoho
The governor’s plan includes hiring 38 new auditors and support staff at the Department of Public Health and an additional seven Department of Health Care Services employees who would oversee a pool of funds meant to reward nursing homes that meet quality-of-care standards for their residents.
Under the governor’s recent budget proposal, the state would spend $3.2 million for the additional workers. State officials said the money was needed after a 2004 law dramatically overhauled how nursing homes were paid for the care of Medi-Cal patients.
In justifying the request for new regulators – which came on the same day Gov. Arnold Schwarzenegger proposed eliminating the state’s welfare-to-work program, as well as cuts to other social programs – the Department of Finance said:
DHCS currently has no tangible or direct mechanism for financially incentivizing, rewarding or penalizing (nursing homes) for the overall quality of care rendered to their residents.
A recent California Watch investigation – reported in partnership with the Orange County Register, the San Jose Mercury News, Sacramento Bee, KQED and others – told the story of Harold Schreifels, a man who died in a San Jose nursing home. Staff had documented his blood sugar falling to dangerous levels yet dismissed his plea for an ambulance.
State health regulators found Schreifels' death so troubling that they levied a $100,00 fine against the home. The facility challenged it, and even though no one disputed the facts of the case, the home saw the fine discounted to $5,000.
The state then allowed the facility to bill taxpayers for some of its legal fees. The new measures Schwarzenegger proposed last week would tighten up the rules over which legal fees the state would pay, although granular details of the plan have not been announced.
California Watch also reviewed staffing and wage data for 650 nursing homes that serve the most Medi-Cal patients. We found 230 of them had cut staffing or wages, or fell below a required staffing minimum.
The proposed changes call for more regulators to complete unannounced staffing audits. Under the plan, these auditors would pick 24 days from the previous three months, and examine the facility’s payroll records to determine whether it met the state standard on each day.
If a facility fell below the standard on even one day, it would be docked a portion of its "labor-incentive funds," which were designed to boost the number of personnel at nursing homes.
State Senate staffers who analyzed the governor's budget plan said the new money should be granted, writing: "Phasing-in the DPH staff to conduct the 3.2 nurse hours ratio audit seems reasonable and is very overdue."
The 3.2 nurse hours ratio refers to a staffing standard set in 2000 that calls on nursing homes to provide 3 hours and 12 minutes of direct-care time to each patient, each day. Much of the care is rendered by nursing assistants.
For those interested in the other nitty-gritty details of the proposal, here are documents released Thursday. They describe the rationale for the changes and a proposed fund meant to reward high-quality care:
Budget.dhcs FACT SHEET for Stakeholders -- AB 1629 Re Authorization
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