Skilled nursing facility regulation bill deserves support

For the more than 110,000 Californians now residing in California’s more than 1,250 skilled nursing facilities, no legislative bill this year is more important than Assembly Bill 1502, carried by Democratic Assemblyman Al Muratsuchi of Torrance.

That’s mostly because it aims to clean up the way nursing homes operate by compelling the state to investigate and regulate the homes’ owners and operators.

Among the homes, says Muratsuchi, there is constant “churn.” Churn often can mean that commitments are not kept.

Example: In a case conference last May, a nursing home director firmly committed herself and her staff to ask one 77-yearold resident each day whether he wants to get out of bed.

The highly educated man, a longtime teacher of handicapped children and adults, is now himself so disabled he cannot get out of bed on his own. The home made good on its commitment for a couple of months, until there was a change of owners and some significant staff turnover.

For the past several months, the individual has usually been kept abed for a week or so at a time, lacking access even to the desktop computer that is his only way to communicate with the outside world because of his congenital deafness.

The promises of the home’s former regime mean nothing today, making this man’s life unstimulating and more lonely than it needs to be.

Adding to this are continuing state rules that require all visitors to have had a negative COVID-19 test within the past two days. Casual or spontaneous visits from friends or relatives, once common, are thus virtually impossible.

So most nursing home residents, despite a thorough vaccination program in the facilities that cut by 96% the death rates seen there early in the pandemic, are almost as isolated as they were in COVID-19’S early days, when virtually no visitors were allowed — a major detriment to the residents’ mental health and heartbreaking to relatives on the outside.

Muratsuchi’s proposed new law aims to fix this by going straight to one main source of the problems: ownership. Nursing home owners with histories of repeat bankruptcies are not unusual. Others lack the financial resources to keep homes operating at a high level if Medicare or Medi-cal payments are delayed.

Says the bill summary, the lives of thousands “are endangered by the state Department of Public Health and its failure to prevent unfit owners from (taking over) skilled nursing facilities.”

The proposed fix would demand that anyone acquiring more than 5% ownership of a home be vetted carefully over 120 days before the takeover date and face rejection if he has a history of bankruptcies or crimes or lacks fiscal resources,

The bill doesn’t spell this out, but such regulation also could end another big problem for nursing home residents, who by federal law are supposed to be asked at least four times yearly if they want to move back into the surrounding community.

Most nursing homes, the federal government reported in 2016, “never ask, or nearly never ask” residents about this, even if they have the financial resources to move back outside.

The U.S. Supreme Court has ruled that such movement is “a basic civil right” if the residents are able and willing.

Meanwhile, COVID-19 health requirements imposed on would-be visitors do not apply to staffers, who studies say were the main source of infections that caused nursing homes to account for 45% of all COVID-19 deaths in pre-vaccine days.

At the same time, COVID-19 safety requirements imposed on nursing home visitors are not imposed on comparable hospital visitors, even though many hospitalized patients are far more vulnerable than nursing home residents of similar age.

All of which means nursing home residents today are not much better off and not much more accessible to friends and relatives than they were when the virus raged uncontrolled through the homes.

Muratsuchi’s plan to attack the problem from the top, by making sure of the fitness of assisted living home ownership is right now the best hope for widespread lifestyle improvements in nursing homes.

Even if it won’t solve every problem, the bill would be a large step in the right direction.