By Brenda Gazzar, Los Angeles Daily News, May 3 2021
A rise in complaints and the coronavirus pandemic are delaying resolution of a backlog of complaints involving nursing homes and other health care facilities in L.A. County, officials say.
About a quarter of “significantly backlogged complaints” that involve these facilities and are about three years old are expected to still be pending in October, according to the Los Angeles County Department of Public Health.
Public Health made the revelation in a formal response to a final report that raised questions about the abilities of the department’s Health Facilities Inspection Division (HFID) to regulate and oversee local nursing homes. The February report by L.A. County Auditor-Controller Arlene Barrera on HFID and nursing home oversight was one of two such reports commissioned by the Los Angeles County Board of Supervisors last year.
In its 19-page response that was signed by Department of Public Health Director Barbara Ferrer and posted online in late April, Public Health said HFID “disagrees” with the report’s assertion that “HFID did not initially have a clear understanding of their contractual obligations.”
According to the Auditor-Controller’s report, HFID management initially said they were only contractually required to complete current investigations that have been received and opened during the current fiscal year, thus implying the state was responsible for completing more than 11,000 investigations that were backlogged as of June 30, 2020.
According to HFID’s contract with the state, however, the division is also responsible for all backlogged long-term care complaints and facility reported incidents received on or after July 1, 2015 along with non-long-term care complaints and facility reported incidents received on or after July 1, 2019, the report stated.
“As a result of our inquiries and DPH’s subsequent discussions with the state, HFID now acknowledges they are responsible for completing 6,219 of the 11,635 backlogged investigations” involving short and long-term health care facilities, the Auditor-Controller’s report stated.
Public Health stated that HFID is responsible for open long-term care complaints and facility-reported incidents received on or after July 1, 2015 and non-long-term-care complaints and facility reported incidents received on or after July 1, 2010 — as long as the workload is “consistent with the volume of work specified in quantity metrics for each year” of the contract.
“Public Health cannot commit to a workload that exceeds the annual caseload and resources articulated in the contract,” the agency added in a statement to the L.A. Daily News.
Public Health also said that HFID received more current complaints and facility reported investigations “than were expected and negotiated” in fiscal year 2019-2020. As a result, the division is prioritizing its current contractual obligations within legally required timeframes, officials said.
The agency also noted in its response that “the contracted workload process was also upended” by the COVID-19 pandemic, which caused federal Center for Medicare and Medicaid Services officials and state CDPH officials to suspend “a significant portion of HFID’s normal workload” for about a year. These officials, the agency said, directed the division to only complete the most urgent regular probes to enable oversight of infection prevention and outbreak response and management within nursing homes.
“As a result, with the current contract’s resource and workload levels, HFID will not be able to fully process all aged intakes” — meaning complaints and facility-reported incidents — “ which are approximately 3 years old, by the conclusion of this contract term,” the county’s Public Health stated.
Since March, however, “CDPH and HFID have undertaken an effort for both CDPH statewide and HFID in Los Angeles County to complete investigation of approximately 75% of significantly backlogged complaints by September 30.”
To help complete this workload, state public health officials directed HFID to perform only a quarter of re-certification and licensing surveys and are engaging other field offices in the state to help process investigations of aged complaints and incidents, the county health agency said.
L.A. County’s Public Health has been “underfunded” until recently with regard to staffing and resources needed to provide oversight of all licensed health facilities in the county, which “led to a large backlog of open complaint investigations and facility reported incidents,” the county agency said. After Public Health advocated to state legislators and testified before legislative subcommittees, it was able to obtain additional funding for the county contract.
Public Health officials also disagreed with the Auditor-Controller’s assertion that HFID management did not demonstrate that they adequately manage or track the various stages of all their current and backlogged long-term care and non-long-term-care complaints and facility-reported incident probes.
“HFID maintains a set of detailed reports, which are updated daily and include all intakes (complaints and facility reported investigations) regardless of age, inclusive of all stages of completion, and for all facility types within the division’s purview,” Public Health said in the statement.
Among the recommendations were that HFID management conduct — or hire a consultant to conduct — a study examining all issues and concerns identified in the report to determine staffing structures and levels and types of positions HFID will need to best meet their contractual needs to ensure resident and staff safety.
While noting that such a study would provide “key data” to support a request to the state for more funding and staff in the future, public health officials said in their response that they do not have available financial resources to support such consultant services. Thus, Public Health would need more funding approval from the state or the county to fund such a contract.
Meanwhile, advocates who have long been critical of HFID’s oversight performance indicated that they were not impressed with Public Health’s formal response to the Auditor-Controller’s report.
“It was striking that the residents and their health and well-being was missing from this response,” Molly Davies, who oversees the long-term care ombudsman program in Los Angeles County that investigates and tries to resolve complaints of such residents, said via email.
Tony Chicotel of the California Association of Nursing Home Reform said DPHs’ defense was “tepid” and read like a contractor talking about their job without much self-examination.
“What kind of self-reflection did the report inspire among the Department of (Public) Health and HFID? I didn’t see much,” he said, adding that the Board of Supervisors requested this report and another by the Office of the Inspector General in light of the problems that had plagued nursing homes even before the coronavirus pandemic.
“I was disappointed that there was no discussion about the quality of the work they’re doing, just the quantity,” Chicotel added. “I didn’t find …any ownership of the experience of residents before COVID or during COVID.”
Chicotel noted that Public Health also attributed at least some of the increase in complaints and facility reported incidents to a new online reporting process. But Chicotel argued it’s more likely that “there’s never been more to complain about, never more grievances about nursing home care.”
“If we think care is getting worse, I think we need to address that,” he said.
L.A. County Supervisor Kathryn Barger said that the response from Public Health confirmed that the county needs additional resources from the state to effectively oversee skilled nursing facilities.
“The state and county are partners in our shared mission to protect those who reside in these facilities and we need greater collaboration from the State in our efforts,” Barger said in part in a written statement.
The California Department of Public Health reiterated in a statement that any proposed change that L.A. County makes in response to the report would need to be approved by CDPH. The county is contracted with CDPH to provide these services to the state agency on behalf of the federal government.
Meanwhile, a final report by the L.A. County Office of Inspector General on nursing home oversight and accountability is due to be released late this month.