Compromised Transparency

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California Is Still Keeping the Public in The Dark on Covid-19’s Deadly Impact on Long Term Care Facility Residents

In the two months since Governor Newsom declared a state of emergency in California, state officials have kept a very tight lid on data about deadly conditions in the long-term care facilities that are ground zero for the pandemic. That lid cracked open slightly over the last two weeks when they published incomplete and inaccurate lists of nursing homes and assisted living facilities that have COVID-19 outbreaks. While those lists need immediate fixing, there is an equally urgent need for state officials to start informing the public on what is being done, if anything, to save the lives of residents at each facility with an outbreak.

Reported Outbreaks In Skilled Nursing Facilities

On April 17, the California Department of Public Health (CDPH) published what it described as a “point-in-time snapshot” identifying 258 skilled nursing facilities where a total of 1,721 residents and 1,279 workers had confirmed cases of COVID-19 as reported by facilities during the prior 24 hours. CDPH has updated the list several times, with the most recent update on May 2 reporting that a cumulative total of 4,189 residents and 2,723 workers had been infected as of that date.

CDPH’s “point-in-time” snapshots obscure the total number of skilled nursing facilities that have had outbreaks. Its reports show large numbers of nursing homes that previously reported outbreaks are no longer reporting infections, without any explanation or verification given.

CDPH has not published a comprehensive listing of skilled nursing facilities that have or have had outbreaks of COVID-19.

CDPH continues to hide information on the numbers of COVID-19 related deaths at each facility even as Los Angeles County is reporting this data on its website for skilled nursing facilities in its jurisdiction. The state reports give only a cumulative number of deaths in California that have been reported by skilled nursing facilities. As of May 2, the CDPH report indicates that 644 residents and 11 health care workers had died due to COVID-19. The number of resident deaths was lower than the Department previously reported, raising serious questions about the reliability of its data. According to the state’s data, about a third of the COVID-19 deaths have occurred in skilled nursing facilities. In Los Angeles County, nearly half of the reported deaths have occurred in skilled nursing facilities and other institutional settings.

The CDPH reporting system has huge holes. Testing is scarce so all of the data is unreliable. CDPH relies on skilled nursing facilities to self-report infections and deaths. Some facilities have not reported any data and many others are likely to have underreported infections. California has no system to ensure that nursing homes are reporting outbreaks as required. CDPH has put its trust in California’s nursing home operators, most of whom have not earned it.

Reported Outbreaks in Assisted Living Facilities

Assisted living facilities in California are regulated as Residential Care Facilities for the Elderly (RCFEs) by the Community Care Licensing Division (CCLD) of the California Department of Social Services. CCLD has been posting very limited information on RCFEs with outbreaks since April 19.

CCLD’s most recent report on May 2 identifies only 37 RCFEs in the entire state with outbreaks. It reports that there were 1,418 positive cases statewide on that date with 177 related deaths. It is very likely that these numbers are an extreme undercount.

California has over 7,300 RCFEs, about 80 percent of which are 6-bed board and care facilities. CCLD is not identifying board and care facilities that have outbreaks, citing questionable privacy and security concerns. This approach leaves the public completely in the dark about life threatening outbreaks in most of the assisted living facilities CCLD regulates.

Also concerning is CCLD’s failure to identify the actual number of positive cases of residents and staff who are infected when a facility reports the number of cases is less than 11. Obscuring the magnitude of outbreaks and whether they are growing or receding is not in the public’s interest.

The actual extent of infections in California assisted living facilities will not be known until universal testing of residents and staff is conducted. In the meantime, anyone looking at the CCLD list should understand that it only identifies a small fraction of assisted living facilities with COVID-19 outbreaks.

No Transparency on Interventions to Mitigate Outbreaks

Other than giving broad assurances that they are working with facilities to control outbreaks, California officials have said very little about specific actions that are being taken at each facility to save the lives of their residents. This is completely unacceptable.

COVID-19 is like a viral wildfire in long term care facilities and should be treated accordingly.

On a daily basis, the state should be giving reports identifying each facility where they are fighting outbreaks, what type of team has been deployed, who leads the team, what they are doing, and what is the current status of the outbreak, resident safety and facility staffing.

Given that long term care facilities are ground zero for the coronavirus pandemic, it should not be a mystery what the state is doing (or not doing) to protect the residents who live in facilities where there is an active outbreak. Residents’ lives matter, they are not expendable!

What Should Be Reported?

California’s reporting system on long term care facility COVID-19 outbreaks should minimally meet these objectives.

  • Ensure that every long term care facility fully complies with reporting and disclosure requirements.
  • Require long term care facilities to disclose and report daily: the existence of new COVID-19 infections for residents and staff; the total number of residents who are infected or who have had infections; the total number of staff who are infected or who have had infections; the number of COVID-related fatalities from the facility (including the number of residents who died following hospitalization or transfer to other sites); the total number of fatalities from the facility, regardless of cause; staffing levels and census for that day; and the steps the facility is taking to treat infected residents and to protect other residents.
  • Require long term care facilities to post their daily reports in the facility, at the facility entrance, and on any facility website; and send the daily reports electronically to residents’ family members and representatives, the long-term care ombudsman program, Disability Rights California (the state’s protection and advocacy organization), the local public health department, the California Department of Public Health, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).
  • The state should post online a daily, facility-specific list with the number of new infections, the total number of residents who are infected or who have had infections, the total number of staff members who are infected or who have had infections, the number of COVID-19 related fatalities from the facility (including the number of residents who died following hospitalization or transfer to other sites), the total number of fatalities from the facility, regardless of cause, and current staffing levels and census.
  • The state’s facility-specific lists should identify all long-term care facilities with outbreaks, regardless of size, including board and care facilities, and should identify the exact number of residents and staff who are or who have been infected or died, rather than giving a numerical range (e.g. <11).
  • The state should provide daily reports to the public on specific actions being taken to protect residents at each facility that has an outbreak, including information on strike teams or other type of teams that have been deployed, who is leading the team, what the team is currently doing, what resources are needed, and what is the current status of the outbreak, resident safety and facility staffing.

See Related Data:

You can download and view the California Department of Health Skilled Nursing Facilities data from previous dates at the bottom of THIS PAGE. This page also displays the current “snapshot” data and cumulative numbers.

Download the CADSS/CCLD Residential Care Facilities report for April 19, 2020 PDF HERE.

Download the CADSS/CCLD Residential Care Facilities report for April 28, 2020 PDF HERE.

Download the CADSS/CCLD Residential Care Facilities report for April 29, 2020 PDF HERE.

Download the CADSS/CCLD Residential Care Facilities report for May 2, 2020 PDF HERE.

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