California and the West : Sweeping Reforms in Nursing Care OKd : Legislature: Homes for the elderly face stiff penalties and would need to increase staff, salaries and training to meet the new requirements. Davis’ signature is not guaranteed.

In a landmark effort to improve conditions for thousands of elderly patients in California’s 1,400 nursing homes, the Legislature on Wednesday approved its most sweeping nursing care reforms in 30 years.

Nursing homes, which have faced a crisis of neglect and generally poor care, would have to add staff, increase pay and improve training for workers, among other changes. The legislation represents the first political acknowledgment that certified nurse assistants, who provide most of the hands-on care for the state’s 250,000 nursing home residents, are ill-prepared for the taxing work they do.

As The Times reported in May, nurse assistants, who earn an average of $7 an hour, often work double shifts or moonlight to make ends meet. Some are responsible for as many as 15 patients, causing them to rush meal times and forgo showers for patients. Their lack of training has led to patient injuries and even deaths, according to government citations.

The bill, AB 1160, by Assembly Majority Leader Kevin Shelley (D-San Francisco) was propelled by increasing pressures from the baby boom generation, many of whom are learning about nursing home problems for the first time through the experiences of their parents. Shelley’s involvement began when he sought an acceptable nursing home for his ailing mother and came up empty-handed.

“All of us agree that our parents and our loved ones, in the final years of their lives, are deserving of better conditions than they’re receiving now,” Shelley said.

The bill doubles fines for violations of state law to a maximum of $50,000 for a death, gradually increases minimum staffing from about 2.8 hours daily per patient to 3.5 hours by 2003, and raises certified nurse assistant pay 5%.

The U.S. General Accounting Office last year published a report slamming California for many of the same problems in nursing homes that were documented 15 years earlier by the state’s watchdog Little Hoover Commission.

To satisfy the nursing home industry, the new legislation includes exemptions that delay staff improvement requirements for a year at facilities that prove they face a hiring shortage.

Another group of facilities would be permanently exempted from the higher staffing, pay and fines: 34 facilities for people with severe mental illness such as schizophrenia. Several of those homes have lengthy records of state citations for deficiencies, including death.

Crucial to getting the nursing home industry’s backing of the bill is a promised change in state Medi-Cal reimbursement from a flat $88-a-day rate to a sliding scale based on patient needs.

But nursing home advocates, who were among the bill’s original authors, said the compromising had gone too far. Although they will not officially oppose the bill because it does help patients, they declined to sign a letter imploring Gov. Gray Davis to sign it into law.

Davis’ signature is far from guaranteed. Spokesman Michael Bustamante said Davis is concerned about Department of Finance opposition to the bill, based on its potential for enormous future costs. The department suggested that the $72 million included in this year’s budget for the bill would fall far short of the long-term costs.

Just five Republicans voted against the bill, among them Assembly Minority Leader Scott Baugh of Huntington Beach, who called the reforms “window dressing.”

The bill’s provisions include:

* Requiring residents to have a minimum of 3.2 hours a day of nursing care by April 2000, increasing by 0.1 hours each year through 2003.

* Increasing classroom training for nurse assistants from 50 to 60 hours, including specialized instruction in caring for patients with Alzheimer’s disease and other dementias.

The bill reiterated the law requiring CNAs to receive 100 additional hours of training on the job.

* Raising fines from $1,000 to $2,500 for violations that risk patient safety; from $10,000 to $25,000 for causing serious harm to a patient; and from $25,000 to $50,000 for causing a death.

In other action:

* Seat belts would be required on all California school buses under a bill passed by the Senate. Backers of the legislation, long sought by safety groups but opposed by some local governments as too costly, praised the move as a breakthrough for 1 million schoolchildren who travel by bus each day.

The Assembly is expected to OK the Senate’s changes to the bill, AB 15, and send it to Davis. The author, Assemblyman Martin Gallegos (D-Baldwin Park), said he is hopeful that Davis will sign it.

Opponents said the bill would expose school districts to lawsuits and force the hiring of bus monitors to ensure that children buckle up.

Under the bill, starting Jan. 1, 2002, every school bus in California would be required to install restraints that protect the torso and pelvic regions of young passengers, unless the federal government forbids such a system. In California, school vans must have seat belts, but larger, heavier buses are exempt from the requirement.

* A bill to require booster seats in cars for children through age 6 was withdrawn from the governor’s desk. State Sen. Jackie Speier (D-Daly City) retrieved the bill, saying she wants to amend it when the Legislature returns from recess in January.

Children are now required to use car seats until age 4 and 40 pounds. Speier’s bill provided exceptions for large children, but the senator said she wants to add height and weight parameters.

* The Senate narrowly approved a controversial bill sponsored by the California Nurses Assn. that would require the state to impose nurse-to-patient ratios for general care hospitals. The nurses union, a major contributor to legislative election campaigns, charges that patient care is suffering as hospitals reduce their licensed nursing staffs to cut costs under managed health care programs. Hospitals deny that.

As hundreds of nurses arrived at the Capitol to demonstrate their support for the legislation, AB 394, by Assemblywoman Sheila Kuehl (D-Santa Monica), the Senate approved it 21 to 17 and returned it to the Assembly for final approval. It is unclear whether Davis would sign the bill.

Nurse-to-patient ratios are in place for intensive care units, operating rooms, nursing homes and psychiatric hospitals. The bill would require minimum ratios for other hospital units, chiefly for floor nurses and emergency room nurses.

* Legislative leaders formally endorsed a measure Wednesday that would require the insurance industry to offer a flat-rate, low-cost auto policy to low-income drivers in Los Angeles and San Francisco. The proposal is expected to easily pass both houses of the Legislature today.

The agreement would require insurers to offer a $450 liability policy to low-income motorists with good driving records who live in Los Angeles. In San Francisco the same policy would be $410. Companies would have to make it available no later than July 1 and offer potential customers a payment plan--$100 down and six monthly installments.

Both counties would be allowed to add a 25% surcharge for the highest risk drivers--men between the ages of 19 and 24.

Last week, lawmakers reached a preliminary deal that would have required the policy only in Los Angeles. After further discussion, they added San Francisco and increased the flat rate for Los Angeles from $400 to $450.

* Complaining that it would have allowed “virtually unlimited access” to state prisoners, Davis announced that he has vetoed a bill that would have given journalists the right to conduct taped, face-to-face interviews with inmates. The bill, AB 1440, by Assemblywoman Carole Migden (D-San Francisco) would have overturned a Wilson administration policy banning reporters from interviewing inmates inside prisons.

Davis said the bill would have provided “journalists preferential treatment by giving them greater access than even members of the prisoner’s own family.”

* Targets of grand jury investigations would be allowed to have their attorneys with them when they testify under a bill passed by the Senate despite strong opposition from former federal prosecutor Sen. Adam Schiff (D-Burbank). Schiff called measure AB 527, sponsored by Baugh, a “bill of rights for white-collar defendants” that will make life more difficult for law enforcement. A spokeswoman for the governor said he has not taken a position on the bill. Now, grand jury targets cannot be accompanied by an attorney.

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Times staff writers Carl Ingram, Virginia Ellis, Nancy Hill-Holtzman and Mark Gladstone contributed to this story.