Category: Mike’s Column

Los Angeles County will STOP transferring decedent bodies from long-term care facilities (LTCFs) to the morgue starting April 1, 2026. A January 30 letter from the LA County Department of Health Services stated its Office of Decedent Affairs will “discontinue all decedent pickup services from LTCFs.” The letter informed ARFs, RCFEs, and skilled nursing homes to “contract directly with a licensed mortuary or transportation provider” to coordinate a pre-approved “drop-off appointment” with the LA County morgue.

LA County stated it does not have the “capacity” to transfer decedent residents of LTCFs. The letter stated there is no law mandating a county retrieve decedent from external facilities including “abandoned or no-next-of-kin decedents.” There is nothing in Title 22 about body disposition. Title 22 87211 states, “…disposition of the case,” and Title 22 80061 states, “Death of any client from any cause.”

Now what? Other counties may have similar policies. San Diego County’s Medical Examiner had specific information specific to “abandoned” decedent individuals including obtaining documentation that there is no next-of-kin for a deceased individual. El Dorado and San Bernardino Counties cite Health and Safety Code 7100. This law seeks to have “an agent under a power of attorney for health care, competent surviving spouse, sole surviving competent adult child, parents, adult sibling, next of kin, or conservator” who has the right to control a decedent’s disposition and accept the responsibility of costs and conditions of interment and disposition.

A county’s public administrator may direct disposition if the decedent’s estate has sufficient funds to reimburse the transporter and pay for other arrangements. It is NOT a cost a facility is legally required to pay as facilities do not have the legal right to direct where a resident’s remains end up.

What should a facility do to protect itself against having to pay for transportation of a decedent’s body if the resident has no next of kin or relative or an estate sufficient to pay for transport and further arrangements?

All facilities are encouraged to NOT admit residents who have no identifiable survivors that can make final arrangements following the death of a resident.

Is that discrimination? No.

A resident’s ability to pay facility fees has never been considered discrimination. Title 22 does not list income, relatives, or ability to pay as grounds for pursuing discrimination citations.

Facilities are also encouraged to create policies and procedures to address resident deaths if a resident is labeled as abandoned and has no survivor willing to undertake the disposition of a decedent body. If you have our admission agreement subscription service, this was emailed. If you don’t you can order our amendment by to your admission agreement at https://rfce4you.com/product/amendment-to-agreement-for-decedent-transportation/. This is not a required addendum to your agreement but, if you decide to use it, DSS is NOT required to approve it because it does not change a facility’s basic services to admitted residents.

California’s “master plan” includes using facilities to house the homeless, place the formerly incarcerated (see new law), and empty mental institutions. The state needs facilities! So why is the Legislature unrelenting in its punishment of facility operators?

          Two new laws are days away that will give residents increased rights including extending rate increases from 60 days to 90. “Why?” is a legitimate question that went unanswered. An additional right for RCFE residents will be the cryptic and vague right “to request, refuse, or discontinue a service.”

          Will DSS explain what that means in timely, updated regulations? That is doubtful as the 2015 resident rights were just “cut and pasted” into Title 22 without the creation of policies and procedures to clarify many of the ambiguities found in those new rights. Government Code 11342.600 requires state agencies to create regulations to “make specific the law enforced or administered by it, or to govern its procedure.” The Office of Administrative Law classifies this type of statute as “susceptible to interpretation.”

          “To request, refuse, or discontinue a service” is certainly one of those laws that need to be made specific. That is not likely to occur given DSS’ history of failing to create clearly written and specific regulations.

          What consequences might facilities endure having to wait 90 days to increase fees? Remember, the state’s minimum wage increases to $16.50 per hour or even higher if a facility is located in a city or county with a much higher minimum wage. Forbes estimates the California cost of living for transportation will increase 14% and utilities will escalate as much as 41%.

          How long will California’s assisted living industry tolerate being pushed around by ignorant legislators before it pushes back? The state continues its unwise and foolish rescue of illegals (remember it wants to place illegals into facilities) and it spends billions on welfare, and soon transgender surgeries.

          However, the state’s attempt at leveraging welfare monies has been a fiscal disaster. The Department of Health Care Services (DHCS) has long mismanaged state and federal funds for its Assisted Living Waiver Program. Its failures include the inability to expand the program statewide, stalling its full implementation at 15 California counties and neglecting 43 others, then suspending the program in September because it ran out of money. This bungling of funds has left thousands of residents that need care on a waitlist until March or even later.

          Other states have mismanaged its funds, and their eligible residents are suing for benefits they know they are entitled to receive. Eligible California residents should also bring a suit against the state and seek an audit of how monies have been spent. Facilities should also bring suit against the state.

          California facilities receive as much as $7,717 per month. Then state nurses get $6.75 per 15 minutes for “rehabilitation services” with an additional $11.36 per 15 minutes for “transitional care coordination,” for an “augmented plan of care development.” These monies are being spent for services DHCS should already provide, but the ALWP monies are being spent on these ambiguous additional benefits.

          Well, California has lots of money, right? Why is this tolerated?

What would happen if the federal government started to regulate the fees and services in California’s assisted living industry? It’s possible as Congress is “studying” the industry, gathering information from three of the largest assisted living providers in the United States to “evaluate resident safety, facility staffing and pricing.” One senator wants to call out the industry’s “exorbitant costs and insidious hidden fees.” Another senator believes there have been “serious health and safety problems in assisted living communities that have not been addressed yet.”

          In response to these perceptions, Congress has created a website asking consumers to share their “bills and experiences” and to get public input into how and why the government should get involved. Will Congress study staffing challenges, rising operating costs, diminished reimbursements and recent assisted living bankruptcies, which hit a record high last year due to “cost inflation” or “reimbursements not in line with rising costs.”

          Through CalAIM, ALWP and similar programs, California has been pushing assisted living facilities to act more like skilled nursing facilities and admit low-income and Medi-Cal residents, aging prisoners, the homeless and persons with mental disabilities, but with higher operating expenses and greater compliance oversight, can the industry afford it?

          According to the 2020 Genworth Cost of Care Survey, the average cost of nursing home care was about $304 per day or well over $9,000 a month, but the average assisted living fee in California is $5,250 according to a recent Forbes study. If California and the U.S. continue to withhold adequate funding and reimbursement to nursing homes and then push assisted living facilities to accept nursing home-level residents, both ARF and RCFEs will be forced to admit post-surgical hip operations and abdominal surgeries. In addition, residents are likely to have various forms of cancers, traumatic brain injuries, strokes, wounds and AIDS.

The most recent statistics show a decline in California nursing homes from 1,230 in 2020 to 1,176 in 2023, attributed to overregulation, higher staffing requirements, and lower reimbursement rates. What about facility declines?

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California governor Gavin Newsom said, “This year California delivered on critical action to make people’s lives better, safer, healthier, and happier in putting people first, safeguarding freedoms, and creating economic opportunity.” Based upon the laws passed, the state has again taken aim at employers but not to create any “economic opportunity.”

          Let’s first clear the air about SB525, the healthcare worker minimum wage. It will NOT increase minimum wage to $25.00 hour for facility staff. The law is for nurse assistants, custodians, housekeepers, gift shop workers, kitchen staff, etc. who work in hospitals, nursing homes and similar medical settings. The raise was justified because of the “courage shown by workers during the pandemic.” Did the fast-food workers display similar courage meriting a $20.00 minimum wage hike starting April 1? Didn’t facility staff exhibit the same if not more courage?

          The state’s new $16.00 per hour minimum wage law will go into effect January 1, but some counties and cities have exceeded the state’s minimum hourly wage. The website to check on your city or county’s minimum wage is https://www.dir.ca.gov/dlse/minimum_wage.htm. Because fast food workers get $4.00 more per hour, it is likely caregivers will leave the assisted living industry to flip burgers rather than flip—turn—residents.

          Cannabis users will get “additional work protections” including the prevention of discrimination during the hiring process and there will be restrictions on terminating the cannabis user for off the job and away from the workplace use.

          More persons are now eligible for conservatorship because they are unable to provide for their personal safety, necessary medical care or have a “severe substance use disorder or serious mental health illness.” That’s in line with the state’s failed attempt to expand Medi-Cal services under the state’s CalAIM and Master Plan programs that force the mentally ill into mental health facilities then get discharged after “treatment” to adult and senior assisted living facilities. Each county, and thus taxpayer, will be on the financial hook for the treatment and care of such persons.

          On January 1, if a facility is located near a church or independent college, it may have to deal with a large number of homeless persons because the state approved the “Yes in God’s Backyard” legislation for use of church and college parking lots and other properties to house “low-income persons.” These sites can “bypass most local permitting and environmental review rules.” Coupled with this is the state’s expansion “of lifesaving treatment” allowing “more mobile pharmacies to be created in communities across the state” to dispense “treatment medications for opioid use disorder.”

A new law now voids noncompete clauses or agreements—both current and future—in employment contracts starting February 14.

          Paid “sick leave” will expand to five paid days per year (more in some cities and counties). The rational for the expansion: “Too many folks are still having to choose between skipping a day’s pay and taking care of themselves or their family members when they get sick,” said Governor Newsom.

          Another new law will expand the number of eligible days a person can have for experiencing a “reproductive loss.” AB352 will support non-Californians entering the state to access “reproductive rights” at taxpayer expense. Low-income Californians of all ages and regardless of immigration status will be able to access Medi-Cal starting in 2024. AB352 protects “all Californians’ and visitors’ electronic medical records related to abortion, gender-affirming care, pregnancy loss and other sensitive services.”

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