Mike's Column

It is very obvious from the deficiencies recently posted on DSS’ website that something is wrong at the States' licensing offices. The problem appears to be inadequate staff training—from management to analysts—on how to cite, what to cite, citing the correct regulations for the specific type of facility, and citing “I want” rather than “it is required.”
Are deficiencies deserved by some facilities? Yes, of course. I wish I could say no, but unfortunately some facility owners just don’t care. A facility in Orange County was recently cited for having numerous broken closet doors that could not be opened or closed as handles were missing; broken bedroom doors that did not open properly; broken exit gates on the property that would not open (in case of fire); dirty kitchen cupboards with broken doors tied together to stay closed; a broken oven door tied with fabric to prevent the door from falling off; and dementia residents not being assessed for over four years. What possible excuse can justify this? Laziness? SSI clients? Apathy? It can’t be ignorance, can it? There is no excuse!
Simple principle—if it’s broken, fix it!! Why delay? What image does this present to families, staff and, of course, residents?
Be your own advocate. Appeal everything. It is rare that an analyst cites accurately, thoroughly, and legally. If you are not comfortable doing appeals, you just can’t let deficiencies go and then get angry when you read them on CCLDs website. More and more consumers are shopping “advocates’” websites and believing Yelp, Facebook and other sites “confessions” about facilities as truthful.
We do appeals and refuse to lose. Our last one is now at DSS in Sacramento with formal complaints being investigated—three LPAs showed up at 3 am and insisted to be let in to “wrap up an old complaint." Really? Three am? That same facility was asked to attend a noncompliance conference, but were thrown out of the conference after two minutes of discussion. Abusive to say the least.

Post date: 11/30/2016

I guess I’ve been preaching it for the 15-plus years I’ve been a vendor, but now it is even truer. During the so-called RCFE Reform Act, 1569.39 was added to state law allowing RCFEs to accept and retain “prohibited conditions,” a shock to the industry. The only condition placed upon facilities in the new law was assisting “residents with accessing home health or hospice services, as indicated in the resident’s current appraisal, to ensure that residents receive medical care as prescribed by the resident’s physician.”

DSS has not revised Title 22, but instead created an “implementation plan,” claiming Title 22 section 87616 is still enforceable which makes facilities seek an exception for prohibited conditions. The new law did not require this but DSS is bypassing the legal provisions deferring to old state regulations. The law must be upheld and not the opinions of a few state employees who write interpretations instead of updating regulations to reflect new laws. 

Post date: 09/19/2016

Many licensees are questioning their desire and motivation to remain in the residential care industry. It’s not that they can’t or don’t provide good care. Rather, it’s a combination of cumulative factors such as new laws and regulations, more demanding families, pressure to lower fees, worker’s compensation, minimum wage, inconsistent enforcement by DSS, and the list can go on and on.  I understand those struggles. I recently spoke to a licensee in the business for 29 years, and she said what many are saying, “I’m just tired.”

I’m often asked the question, “What’s the future of residential care?” It depends. Are you an optimist or a pessimist? To become an administrator today, one must take the 80-hour initial course with a 100-question exam, and to get a new facility license, if the administrator has been certified over five years, they, too, must take the 80-hour course. On the positive side, that means less competition and fewer care facilities. Do you see that as good or bad? The elder care industry can be very rewarding, but it is also very hard work. Caregiving is the most stressful job and occupation in the United States, and California is not “business friendly.” In fact it ranks last in the nation for finding qualified employees and for supporting businesses.

My hope is that those facilities that are resident-focused, provide excellent care and comply with laws and regulations weather the storm, and those who really aren’t committed to their residents leave the industry.

Post date: 10/01/2016

What predictions are being made about 2017? Prosperity? Economic uncertainty? A health care crisis? For the assisted living industry, will the legislature continue its legal, punitive barrage? Will DSS continue moving toward a medical model? What would an RCFE look like under skilled nursing regulations? I don’t know the future, and it seems no one does, or anyone who does know is not willing to confess.

Since RCFEs can accept prohibited conditions, is accepting TB residents in a private, isolation rooms next? Will RCFEs be forced to hire nurses taking residents with IVs, infused under caregiver supervision? Will the “caregiver” disappear entirely and only certified nurse assistants be allowed? Can facilities cope with $11.00/hr. minimum wage and increased sick time allowances?

Will assisted living facilities be admitting sicker, needier clients allowing the state to avoid higher health care expenditures found in skilled nursing? Then, in so doing, will the legislature punish facilities with stricter laws forcing facilities to close and relocate clients into more expensive settings or into skilled nursing? The legislature wants to avoid costly placements of the aging population, but then punishes facilities that help. It can’t be both ways!  

Post date: 11/30/2016
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