Amid criticism of past oversight efforts, Los Angeles County supervisors approved a new contract Tuesday that redefines state and local responsibilities for inspecting nursing homes and other health facilities and investigating complaints of abuse, neglect or inadequate care of patients.
The new contract will give the county more money and scale back its duties.
Los Angeles County is the only local government in the state that is contracted to inspect health facilities. Elsewhere, the state handles licensing duties and investigates complaints.
Under the new contract, the annual budget of the county program will increase from $26.9 million to $41.8 million and will allow the county to hire about 70 more workers to conduct yearly inspections and investigate complaints.
The state will take over initial certification of facilities and some other licensing duties.
During the first year of the three-year contract, when the county will be hiring and training new staff, the state will also take over investigation of complaints at facilities that do not provide long-term care, including acute care hospitals and psychiatric facilities.
County officials said the change will lead to better oversight of care for vulnerable patients, but that the program still needs more money.
"We feel that this is a great step forward," said Los Angeles County's interim public health director, Cynthia Harding. "It's a first step toward getting us to where we need to be."
Debra Goode, a registered nurse with the county's health facilities inspection program, told the supervisors that the new contract will help to "position us for future success."
"We know how critical the work is that we do in protecting the frail, the infirm and the developmentally disabled in Los Angeles County," she said.
Advocates were more skeptical that the elderly and disabled living in the homes will be better protected. Michael Connors, an advocate with the California Advocates for Nursing Home Reform, said the added positions are needed, but the effects of the new contract are "hard to predict."
"The state has richly rewarded the county for its shockingly bad performance, so it seems to have little incentive to improve its performance," he said. "There don't seem to be any new accountability measures, and we've seen no sign that county managers have any concern about the fate of the residents of the many substandard nursing homes in L.A. County."
The county's public health department has been under scrutiny for a backlog of about 10,000 investigations, many of which have been open for two years or more.
County officials argued they weren't getting the state money needed to do an adequate job and had threatened to turn the entire program back to state investigators. Two of the county supervisors, Hilda Solis and Don Knabe, made personal trips to Sacramento to push for increased funding.
The supervisors said Tuesday that they were happy with the outcome of the negotiations, calling the new contract a win for the county. Some expressed misgivings about how the state would be held accountable for its share of the work.
Harding said county officials will meet regularly with state officials to talk about the program's progress and also will seek meetings with federal overseers.