During the current pandemic, California Governor Gavin Newsom has been widely praised for issuing a shelter in place directive ahead of other states, helping to expand patient access to intensive care beds and ventilators, and securing more personal protective equipment (PPEs) for hospital workers.
Unfortunately, Newsom’s response to the crisis facing people in nursing homes and residential care/assisted living facilities has not been praise-worthy at all.
Residents of such long-term care facilities (LTCs) are highly vulnerable to COVID-19 infection due to their advanced age and accumulated chronic diseases or disabilities.By the Newsom Administration’s own count, residents and staff at 191 California nursing homes and 94 small residential homes now have the virus—with far more infections expected.
Yet, in response to this crisis, the state Department of Public Health has just provided regulatory relief to the long-term care industry. Instead of increasing public oversight, California has relaxed it, allowing private nursing homes to cut staffing. In addition, California is requiring un-prepared facilities to admit some of the sickest coronavirus patients. This is a recipe for disaster.
COVID-19 has already highlighted our national failure to develop and enforce adequate patient safety protections in the for-profit nursing home industry. One of the first reported cases of coronavirus infection occurred at a for-profit nursing home in Washington state, owned by the national chain, Life Care Centers of America, which has a long history of problems. This particular facility had only 69 percent of the Certified Nursing Assistants (CNAs) and 88 percent of the total nursing staff that experts say are needed for residents with the lowest care needs. In 2019, the facility was cited by state inspectors for failing to provide and implement an infection prevention and control program.
A Long-Standing Failure
Many of California’s nursing homes have similar deficiencies. Most are so short staffed that workers don’t have the time – or training – to follow basic infection prevention procedures – like washing hands, isolating patients, and keeping ill nurses and aide from coming to work. Nursing home aides are so poorly paid that they often work two or three jobs, thus increasing the risk that they will, unknowingly, spread the coronavirus to other healthcare workplaces and their families.
In southern California, we are already experiencing the results of short-staffing and lack of effective regulation, particularly in situations where workers have no collective bargaining rights or protection for whistle-blowing about conditions unsafe for them and their patients.
On April 7, the public health director for Los Angeles County had to advise families that it would be “perfectly appropriate” to pull their loved ones out of long-term facilities—after coronavirus infections were reported at 121 nursing homes and other communal living institutions in the county— including a home in Redondo Beach with 38 confirmed cases and four deaths. Meanwhile, staff at a Riverside County home were so fearful about their exposure, due to lack of testing and personal protective equipment (PPE), that they didn’t show up for work, forcing the evacuation of 84 residents.
Before situations like this become more common and dangerous statewide, Newsom must reconsider and reverse his grant of regulatory relief for an industry in need of more oversight, not less.
Steps California Should Take
Instead of giving nursing home owners and managers a freer hand, the state should be requiring more patient safety reporting and accountability. No nursing home should be forced to admit COVID-19 patients. Only nursing homes with dedicated COVID-19 units should be accepting such patients. Because many people with the infection don’t have symptoms, it’s critical that nursing homes and assisted living facilities test all staff and residents, as soon as testing capacity increases.
Not only should California immediately restore its minimum staffing requirements, staffing levels should be higher for any facility that cares for patients with COVID-19. Plus nursing home workers need more than the $500 additional stipend that the governor has allocated. As one nursing home safety expert told me, this payment is “a joke because it’s not enough money to keep them at work or keep them from working two or three jobs. What’s needed is hazard pay. The governor may think he’s doing something, but it’s way too little, way too late.”
Finally, we need far greater transparency about the spread of the virus in the state’s nursing homes and assisted living facilities. The California Department of Public Health has not disclosed which long-term care institutions actually have residents with the virus. Los Angeles County is one of the few actually reporting names of facilities on a daily basis. We can’t know the full extent of the pandemic, without statewide reporting on the problem—so patients, their families, and prospective users of these facilities can act accordingly.
In Canada and other parts of the U.S.,there have also been stronger responses to the crisis. For example, British Columbia has taken control over staffing levels in all provincial nursing homes, providing their workers with adequate pay so they don’t have to juggle two or three jobs. The Republican governor of Maryland has taken more aggressive measures to monitor that state’s facilities than Democrat Gavin Newsom has.
It’s time for Governor Newsom to address this emergency before a crisis turns into a catastrophe for residents and staff at his state’s long-term care facilities.