After Pandemic Disaster, California Looks to Solve Longstanding Nursing Home Problems

It’s been a year of trauma and loss in California’s long-term care homes, where thousands of COVID-related deaths occurred. The scourge of COVID-19 helped spotlight longstanding problems in the skilled nursing industry, and advocates across the political spectrum say nursing homes are now at a crossroads, as state and federal lawmakers put forward legislation to support care workers and reform the way these facilities are run.

Over the last year, reporter Molly Peterson has covered the pandemic in nursing homes, and she spoke recently with KQED Morning Edition host Brian Watt about what the industry is now facing.

The following has been edited for length and clarity.

Remind us how the pandemic played out in nursing homes?

Molly Peterson: When the virus started to spread there weren’t a lot of extra PPE [personal protective equipment] supplies like masks and gowns on hand. Facilities already had a history of at least some infection control violations, existing staffing shortages got worse, and regulators had to waive rules. It was always going to be hard to keep the virus out of nursing homes, but overall, a lot of places were just not ready, despite having a responsibility to be doing all the things that we already knew about controlling an outbreak.

So how are legislators in Washington and Sacramento trying to solve this?

On the federal level, lawmakers are still just dealing with pandemic problems. Some East Coast senators have proposed bills aimed at creating staffing teams and supporting training for people who might potentially work in these homes in California. There’s a bill that would create requirements to prepare for the next disaster or a pandemic. In this state, some lawmakers and advocates say everything was made worse by the bigger problem of how we oversee nursing homes and hold them accountable for taking care of people.

Is tackling these bigger problems something that’s on the table, too?

Patient advocates and some California legislators have put forward a package of seven bills aimed at reform. It’s called the PROTECT Plan. Some of it’s about accountability, like raising penalties for regulatory violations where someone dies. There’s language in one of the bills about patient rights that would protect residents from getting evicted without their consent.

But the bill that’s getting national headlines is SB 650, which was introduced by a state senator from Southern California, Henry Stern. It would require nursing home operators to report comprehensive financial information to government regulators.

“We don’t have enough transparency in the industry right now so that people who are trying to make choices about where to send their loved ones know if every dollar of Medi-Cal or of those taxpayer-funded health care benefits are going to make it either to their loved ones or to the care workers serving them,” Stern said. “How much extra profit is being squeezed out on the way from that dollar’s origin? We don’t completely know.”

Stern says the goal is to further expose the corporate structure of these for-profit nursing homes and the bigger chains. They’ll have to submit far more detailed financial reports to show how they’re spending money, including money they get from the government.

So why does it matter if we, the public, know more about how these homes are run?

Nursing homes say they’re struggling financially and that many may now have to close. They’re eligible for and have sought government aid, including in the form of low-interest loans for some facilities. But the reason it looks like they don’t have a lot of money is that there’s more than one company behind a single nursing home or even a chain of them. Owners make webs of corporations, different companies registered with the state for property, for operations, for management. It helps them limit their financial liability. The industry says they have to organize things this way to stay in business. The problem is it’s harder to track how much money they spend on residents and how much goes into their pockets as profit.

Who’s taking sides on these bills?

California Advocates for Nursing Home Reform and a union, the SEIU, co-sponsored this financial responsibility bill with state Sen. Stern. Generally, the nursing home industry and advocates for the homes themselves say that more accounting requirements are burdensome and defeat the purpose, which is to make sure that as much money is spent on patients as possible.

What do these reform efforts leave out?

The biggest unaddressed problem right now is staffing, and it goes back decades. There are ways, called waivers, for nursing homes to have fewer people than the rules really say are a good idea. Lawmakers aren’t really addressing the maze of waivers that exist right now, even though academic studies increasingly show that staffing improves health outcomes for residents. Administrators say there’s a lot of red tape. It’s a real political quagmire, so whether politicians start to address staffing is probably going to depend on how all these other reform bills turn out and on whether the public gets involved and pays attention.