State Plan on Nursing Home Inspections Angers Critics

Senior citizen activists, county health officials and prosecutors who handle nursing home abuse cases are reacting with dismay and anger at a proposal by the state to replace Los Angeles County’s nursing home inspection program with an operation of its own.

In Gov. George Deukmejian’s budget, state health officials estimated that about $1 million a year could be saved by the state taking over inspections at the county’s estimated 400 private nursing homes. State employees would take the place of county employees in paying periodic visits to the homes to monitor the quality of care and follow up on complaints.

The governor’s decision has provoked widespread opposition in Los Angeles County, the only county in the state that employs its own nursing home inspection teams. The criticism has prompted state Sen. Diane Watson (D-Los Angeles), chairman of the Senate’s Health and Human Services Committee, to schedule a hearing on the issue later this month in Los Angeles.

Critics say the state’s decision threatens to break up a well-run system that has been in place since 1966. County officials said the aggressive prosecution of nursing home operators in violation of care standards could be jeopardized if county inspections are halted.

“The county of Los Angeles does the best job in the whole state,” said Adele Erenberg, head of the health task force for the seniors’ activist group, Gray Panthers, in Southern California. “The state has not got a record to fall back on to show they can do a better job.”

Susan Frauens, a Los Angeles deputy city attorney who is supervisor of the consumer protection section, said she was very distressed by the state’s move.

“The County of Los Angeles has been a model agency of how nursing home cases should be investigated,” Frauens said.

State officials, however, said they suggested the takeover because the state is facing a budget crisis and must save money wherever possible.

“One of the very important things we want to get across, and we’ve made it clear to the Los Angeles County staff, is that it is not an action that is a statement of poor performance or anything like that. It is frankly a money issue,” said Teresa Hawkes, deputy director for licensing and certification with the state’s Department of Health Services.

The situation in Los Angeles County is unique because it is the only local government in California that inspects nursing homes, hospitals and home health-care services through a contractual agreement with the state. Everywhere else, state personnel conduct the surveys.

Prosecutors have filed cases against more than 200 operators in the last decade, said Ralph Lopez, the county’s associate deputy director of environmental management, who oversees the inspection section. Prosecutors said that working with county inspectors ensured a level of cooperation that does not always exist in other counties where the state conducts the inspections.

State documents show that another consideration was that the nursing home industry is expected to support the change.

A state memo that included reasons for the switch, stated: “Over the years, the nursing home industry and provider associations have been critical of the state’s contract with Los Angeles County. Termination of the contract is therefore projected to be favorably received by the providers.”

“I find it slightly amusing, though it’s no laughing matter, that one of the stated reasons” for the switch is that “the nursing home industry and providers have been critical of the state contract,” Lopez said.

However, Dave Helmsin, spokesman for the California Assn. of Health Facilities, which represents more than 900 operators, said the industry is neutral on the issue.

“We don’t have any particular problem with who does the inspections, as long as they are done in a credible fashion and done within state standards,” Helmsin said.

County health officials dispute the state claims of a $1-million savings with the state taking over nursing home inspections. They said the county will contest the state’s figures at the public hearing.

Plan to Cut Jobs

One way the state proposes to economize is to eliminate some positions and to close two of the county’s five regional offices.

Hawkes said more detailed studies of potential savings will be calculated soon. If it appears the state will not save money after all, the plan will be dropped, she said. The state will also consider allowing the county to remain in charge of the program but only if comparable savings can be demonstrated.