Herbert Spenser, not Charles Darwin, coined the phrase, “survival of the fittest.” In this context, which facilities will survive: the state’s high taxes and rising minimum wages; rising worker’s compensation premiums; higher food and utility costs; rising liability insurance premiums (if any carriers stay in California); fewer and a less qualified workforce (or the forced hiring of CNAs); the proliferation of punitive laws and regulations; and the acceptance of nearly all health conditions?
To survive, legally, facilities must deny admissions to SSI and low-income residents, and force the state to pay for the care when these individuals are placed in skilled nursing because of the government’s “higher everything” concept to care providers. The state wants individuals in assisted living, then makes it nearly impossible for assisted living facilities to manage the rising cost of providing care. The state prefers to have individuals in social settings to avoid paying for care in skilled nursing facilities.
It was in a 1538 letter to Thomas Cromwell that the Duke of Norfolk said, “a man cannot have his cake and eat his cake.” In other words, if you have a piece of cake you cannot eat it and still have that piece of cake. California believes it can over-regulate RCFEs (have its cake) and not pay the costs of skilled nursing (eat it), but when RCFEs can no longer afford to operate because of those rising costs, the state still wants the cake it just ate.
Solution? Facilities will go “underground”—operate without a license; hire and pay individuals substandard wages, in cash; not pay taxes; and take low-paying clients. However, there will be absolutely NO state or federal oversight. These facilities will be “off the radar.” Who pays the ultimate price? The residents as no one will be monitoring their care or safety.