Surprised and appalled, legislators pledge assisted living reforms - Brian W. Jones

Surprised and appalled, legislators pledge assisted living reforms

California lawmakers pledged to increase penalties and boost inspections in response to "Deadly Neglect," a three-day series published this week by U-T San Diego that showed serious deficiencies in...


the state's assisted-living homes.

Legislators were appalled at findings of the U-T's joint investigation with the CHCF Center for Health Reporting at USC, which among other things disclosed that caregivers who abuse or neglect residents are rarely prosecuted and the maximum fine for injury or death at a facility is $150. 

"As a legislator and as a Californian, these reports are very troubling and clearly warrant further investigation," said Senate Health Committee Chairman Ed Hernandez, D-West Covina. "It is clear that $150 is far too low to deter bad behavior at facilities that increasingly seem to be acting as quasi-nursing homes."

The maximum fine for similar violations at nursing homes regulated by the state Department of Public Health is $100,000, but assisted-living centers are not medical facilities and are regulated separately by the state Department of Social Services.

Sen. Leland Yee, the San Francisco Democrat who chairs the Senate Committee on Human Services, said he plans to hold a hearing on assisted living and elder care when the Legislature reconvenes next year. He said he was concerned to learn that at least 27 people have died due to neglect or poor care since 2008 at assisted living homes in San Diego County, as tallied and detailed in the U-T report.

"I was particularly surprised by the large number," Yee said. "The percentage seemed extraordinary."

The U-T also highlighted how the minimum frequency for regular inspections of assisted living homes is every five years, significantly less often than other states.

"Nobody should die due to neglect or poor care in any senior facility," said Sen. Joel Anderson, the La Mesa Republican who serves as vice chairman of the Senate Health Committee. "Increased inspections will lead to safer senior facilities and no amount of fines will substitute for the necessity of regular inspections."

The series uncovered cases of residents being injured, molested and even dying from neglect inside the homes, which range from suburban split-levels to sprawling campuses. At the nonmedical residential centers, seniors hope to live out their days in supervised settings with help for everyday tasks.

In some cases, clients were discovered lying in their own waste for hours or days after accidents to which no one responded. In other cases, caregivers failed to call 911 or summon medical aid for residents in need of higher levels of care.

Regulators are overwhelmed by a rising workload and regularly fail to refer possible crimes to prosecutors. The internal Department of Social Services police force has not made an arrest in nine years.

"We definitely need to speed up and increase inspections," said Assemblyman Richard Pan, D-Sacramento, a pediatrician who chairs the Assembly Health Committee. "We should probably look at the fine structure, too."

Hernandez and Pan both noted that their committees do not have direct responsibility for the state Department of Social Services, a sprawling agency that oversees 80,000-plus facilities including child care centers and homes for the mentally ill.

The two lawmakers do have responsibility for the health department, which in many other states oversees assisted-living facilities. California is one of only two states, along with Virginia, that delegates assisted living oversight to a Department of Social Services. Another 37 states give that power to their departments of health or public health.

"These are issues that are good candidates for potential reform," Assembly Majority Leader Toni Atkins, D-San Diego, said in prepared remarks. "I will be looking closely at these suggestions as well as any others that present themselves during the course of my review of the issues."

Assemblywoman Shirley Weber, the San Diego Democrat elected to her initial term in November, said she planned to learn more about issues raised in the series and propose whatever legislative remedy she thinks is needed.

"We must explore all possible causes as well as solutions such as looking at recent cuts to the social safety net and considering making reinvestments as needed," her statement read.

Assemblymen Brian Jones, R-Santee, and Brian Maienschein, R-San Diego, both used the same word - "appalling" - to describe the cases described in the series.

"While there are a vast majority of facilities and caregivers who are providing wonderful services to our elderly population throughout the district and California, those individuals who abuse their position and harm the elderly need to be punished," Maienschein said.

Consumer groups representing the elderly have long knocked on legislators' doors in Sacramento to call for stronger laws governing assisted living homes. Most of their efforts failed, they said. Pat McGinnis has spearheaded many successful bills protecting the elderly as executive director at California Advocates for Nursing Home Reform, one of the nation's best-known groups in the field. It also monitors assisted living issues.

This year, McGinnis said, she wrote three draft bills to upgrade assisted living homes, including one that would require the Department of Social Services to post inspection reports and violations online, as is done in some other states. She couldn't find a legislator to carry legislation, she said Tuesday.

McGinnis said she is encouraged to hear about the new interest following the U-T San Diego series, but she said she is cynical after attempting to spur reform efforts in the past.

"There are legislators that care," she said. "There's no question about it." If legislators were to mandate the Department of Social Services to increase inspection frequency, she said, "That takes money. They're going to have to take on more staff."

David Chong of Mount Helix runs a company that provides in-home care for needy seniors and formerly ran assisted living centers. He is not convinced that higher fines or more frequent inspections will solve problems identified in the industry, but he does think the department should post its documentation online to inform consumers.

"There's not big profit margins in small board and care homes, so any increase in regulation must weigh costs versus benefits," Chong said. "But if I were king for a day, I would push consumer access to information."

San Diego Union-Tribune