Mike's Column

According to DSS, the most cited deficiencies in 2015 were lack of or no initial staff training; excessive hot water temperatures; facility not clean, safe and sanitary; no annual medical assessment for dementia residents; improper storage of medications; toxic substances assessable to dementia residents; and no fingerprint clearances on employees.

   However, in 2016 and 2017, facilities are being cited for not conducting fire and earthquake drills every three months. Drills are ONLY required of facilities that have delayed egress doors or locked perimeter fence gates to prevent wandering (see 87705 and 80077.3). Why DSS is citing facilities without such devices is unknown, but we have encountered numerous LPAs insisting this is a requirement.

   In ARFs, Title 22 section 80023 requires all facilities to do drills, but once every SIX months. Under Health and Safety Code 1502.5 and Title 22 section 87100, RCFEs cannot be forced to comply with ARF regulations. RCFEs, under H&S Code 1569.1, are “carved out” from other community care facilities and are licensed as a completely separated entity. No drills unless “secured.”

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
Subscribe to Mike's Column