New Bill Seeks Reforms at Nursing Homes

Undaunted by past failure, state lawmakers revisited the issue of nursing home reform Tuesday with a proposal to increase both penalties for poor performers and pay for low-wage workers.

A similar bill struggled through the Legislature last year only to be vetoed by the governor. But this year’s bill is sponsored by Gov. Gray Davis himself--his long-promised response to critics of his veto.

Assemblyman Kevin Shelley (D-San Francisco), who introduced both the new and the vetoed bills, called it “a tragedy” that workers providing most of nursing home care make just $7 an hour.

“I simply will not rest until we fundamentally change this system,” Shelley said.

If the reforms stick this time, they will come none too soon. Like a human tsunami, California’s senior citizen population is expected to nearly double in the next 20 years--to 9 million.

In announcing his “aging with dignity” initiative earlier this year, Davis said he would improve options for frail seniors to remain in their own homes instead of entering nursing homes.

But his first foray, the bill approved Tuesday by the Assembly Health Committee, emphasizes the carrot-and-stick approach that has been a hallmark of the governor’s education reforms.

He wants to set aside $10 million for awards to nursing homes that maintain the highest quality of patient care. Nursing home watchdogs complain that the establishments should not be rewarded for obeying the law.

At the same time, fines for nursing homes that seriously injure residents would increase. The maximum for deaths would quadruple, from $25,000 to $100,000.

Representatives of nursing home companies said higher penalties can exacerbate problems by leaving struggling facilities poorer. “Adding penalties on top of penalties . . . falls very far short in terms of comprehensive reform,” said lobbyist Dave Helmsin.

Nursing home workers complain that the fine components of the bill are weaker than in last year’s legislation, because nursing homes would be allowed significant discounts if they don’t contest fines.

Current law gives homes 15 days to pay; this bill would give them 30. Shelley’s prior legislation provided no discounts.

“Last year . . . you paid upfront or paid interest, same as you or I would on a traffic ticket,” said Beth Cappell, a lobbyist who represents unionized nursing home workers.

But she characterized the bill as largely stronger and more thoughtful than last year’s.

For instance, the legislation clearly divides the respective duties of state inspectors and technical advisors, so “the guy who tells you how to fix the problem won’t give you a citation,” she said.

But Prescott Cole, an attorney with California Advocates for Nursing Home Reform, said asking state employees not to report problems they observe during advice visits will weaken enforcement.

Davis’ main objection to the 1999 bill was its price tag, estimated at $125 million to $250 million.

Yet early indications are that this year’s version could cost even more. The seemingly innocuous wage increase may rank among the most contentious issues.

Davis has proposed a 5% raise for nursing staff, including certified nurse assistants who make about $7 an hour. The money for the raise would come from the Medi-Cal program.

Budget subcommittees of both houses of the Legislature have doubled Davis’ suggested figure to 10% and extended it beyond nursing staff to all nursing home employees, such as housekeepers and laundry workers.

Workers unions say additional safeguards are needed because a 5% raise the state provided last year was not awarded in a timely fashion. The Service Employees International Union says a third of unionized homes in Northern California have yet to pass on the state raise. The situation is even worse in Southern California, the union reports.

At a budget hearing Monday night, a few legislators expressed dismay about the situation.

“In some ways it feels like we made a policy decision and . . . it’s essentially being thwarted,” said Assemblyman Marco Firebaugh (D-Los Angeles). “I’m kind of wondering what kind of club we have to use to make sure that this time it gets to them.”