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California Gets Tough on Assisted Living Regulations

This past week, the California state legislator announced a total of 12 bills that are aimed at curtailing problems in assisted living facilities throughout the state. The legislative efforts have been hailed by consumer advocates as the most sweeping in almost 30 years.

Since several well-publicized incidents of elder abuse and an incriminating review of over 7,000 state records, California’s assisted living homes have been under indictment. In one media investigation, 27 deaths of assisted living residents were chronicled by the San Diego Union-Tribune and the California HealthCare Foundation’s Center for Health Reporting. Reports of lax regulations and lack of consistent enforcement have caused the state’s legislators to take note, many of whom have heard from constituents who lost family members.

Major problems found in the investigation included primarily medical infractions and level of care issues. Medical issues ranged from failure to respond to resident symptoms or schedule needed medical appointments to significant medication errors and unsafe medicine storage. It was also found that many residents needed higher levels of care than could be provided in the facilities in which they resided.

It appeared that most errors and infractions were due to a combination of poor staff oversight, insufficient staffing, and lack of training. In addition, facilities had insufficient incentives to improve care, due to problems in state oversight, including the following:

  • Insufficient fines and penalties for regulatory violations, even those resulting in death (the maximum fine is $150 per violation);

  • Failure to collect levied fines; i.e., only around half of fines levied in the last six years have been collected;

  • Facility inspections taking place as infrequently as every five years, less frequently than in most states;

  • Failure of regulators and licensing board to track medical errors in facilities.

Recommended changes in the raft of reform bills including the following provisions:

  • Increase in mandatory training for facility workers, including dementia care training;

  • Higher fines for regulatory infractions (up to $1000 for minor offenses and up to $15,000 for serious harm or death);

  • More frequent facility inspections, including unannounced visits;

  • Requirement for facilities to carry liability insurance;

  • Increased state funding;

  • More timely completion of complaint investigations;

  • Creation of an online consumer information system that would include data on all licensed assisted living facilities in the state (including inspection records and records of violations);

  • Strengthening of license suspension and revocation procedures;

  • Requirements for medical personnel at facilities that accept residents with particular health conditions;

  • Creation of a bill of rights for assisted living residents, along with injunctive relief for violations.

The legislative effort is bipartisan, and Governor Jerry Brown is also weighing in. His 2014 budget proposal raises facility licensing fees, adds over $7 million in funding, and increases the number of positions in the state’s licensing division. The budget proposal also calls for large increases in fines.

The Senate Human Services Committee plans to hold a joint oversight hearing on assisted living care with the Assembly Services Committee on February 11, from 9:00 a.m. until noon. The hearing will be held at the State Capitol in Room 4203. At 1:00 p.m., the legislature’s Business, Professionals and Economic Development Committee and the Health Committee will also hold a joint meeting on the subject.

At Homecare California, we’re pleased to see that the State of California is taking such a pro-active stance in protecting its oldest citizens. By and large, assisted living facilities provide wonderful care to their residents. But until we can guarantee a uniform standard of excellence, California still has work to be done.

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