After ‘Really Horrible’ Mortality Amounts in Nursing Homes, California Seeks Their Financing Again

SACRAMENTO, California – About one in eight Californians who have died of covid live in a nursing home.

They are among the weakest residents of the state: nearly 9,400 mothers, fathers, grandfathers, aunts, and uncles that Californians have trusted in nursing homes to care for. An additional 56,275 confirmed covid cases among nursing home residents have not died.

“The number of infections and deaths in nursing homes,” said Jim Wood, a Democrat who chairs the state congressional health committee, at a recent hearing he convened in nursing homes: Skilled nursing facilities in California are truly amazing. “I expect better from us.”

The unrelenting spread of Covid-19 has exposed deep, systemic problems with the quality of care – or the lack of them – in nursing homes across the country. In the nation’s most populous state, the industry’s record during the pandemic is prompting leaders to rethink how they are paid and monitored.

Governor Gavin Newsom’s administration is drafting a proposal to tighten state funding more directly with efficiency: Of the state’s approximately 1,200 skilled nursing facilities, those that are responsive new quality standards will receive a larger share of state funding than establishments that do not meet them.

But exactly how the Golden State will measure the quality of care and allocate the roughly $5.45 billion per year that nursing homes receive is far from settled – and promises to spark a One of the biggest healthcare battles of 2022. As the legislature debates those details as part of state budget negotiations, the nursing home industry vows to oppose any proposal. There are no proposals that tie Medicaid payments to quality measures such as employee levels, wages, and revenue.

In fact, the industry plans to argue that it needs more money to deliver better results – and it holds considerable power in the Capitol.

Over the past decade, it has spent at least $10 million influencing lawmakers and has awarded one or more political donations to Newsom and at least 105 current members of the legislature including: 120 members, according to a KHN analysis of campaign finance records.

But advocates for patients and family members who have lost loved ones in nursing facilities during the pandemic are campaigning counterattacks to convince lawmakers that now is the time to overhaul the system.

“There are a lot of problems that people have been complaining about for a long time,” said Charlene Harrington, professor emeritus of behavioral and social sciences at the University of California-San Francisco and a nursing home expert. . “This is an opportunity to fix those problems.”

At least 140,790 The latest data from the US Centers for Disease Control and Prevention has recorded covid deaths in US nursing homes. Older adults are at higher risk of dying from covid, and coronavirus spreads more easily in institutional settings such as nursing homes and assisted living facilities.

That’s one reason Craig Cornett, CEO of California Association of Medical Facilities, argues that blaming nursing homes for the high rates of fallopian tube infections, especially early in the pandemic, is unfair. Not only are their residents naturally at higher risk than the rest of the public, he said, but facilities are forced to take in transferred patients who have not been tested for the virus, they are not provided with. adequate personal protective equipment, and they suffer when employees join the community and then put it on the job.

Cornett also points to federal statistics showing that California has Lowest nursing home mortality in the country and is one of the highest Vaccination rate of staff.

But many studies in California and other places found that nursing homes with fewer nursing staff had significantly higher rates of fallopian tube infections and deaths. That devastating outcome is reinforcing a two-decade-old argument by patient advocates that nursing homes must hire more workers.

“Some of the problems we see during the pandemic could be avoided if nursing homes were staffed enough,” said Harrington, co-author of the December 2020 issue. research for the California Health Care Foundation found that nursing homes with lower staffing levels earlier that year had more than twice the rate of cases than nursing homes with higher staffing levels. (California Healthline is an editorially independent publication of the foundation.)

Some legislators and patient advocates argue that the best way to improve care is to increase staffing, and the best way to achieve that is to change the complex formulas that determine the level of care. The daily wages of nursing homes are covered by Medicaid, the government’s insurance program. about two-thirds of nursing home residents.

Currently, Medicaid reimburses a portion of the costs that nursing homes spend on staff, administrative and other costs, paying them a higher percentage of staff costs than administrative costs. Facilities can receive bonuses for meeting quality standards – although bonuses are limited and have been criticized for not boosting performance at the facilities that need it most.

The California Department of Health Care Services, which administers the state’s Medicaid program, known as Medi-Cal, is drafting a plan to eliminate bonuses and integrate quality measures into payment levels. daily Medi-Cal payments that nursing homes receive. The department is looking at multiple ways to measure quality, spokesman Anthony Cava said in a statement: Nursing homes that offer more education and staff training programs may receive a fee-based allowance. higher, as well as institutions with more staff and fewer staff turnover.

It was a start for the nursing home industry, which doesn’t see staffing as an adequate measure of how well residents are doing. Instead, Cornett, whose lobbying group represents more than 800 nursing homes, said facilities should be classified based on a patient’s number of falls and infections, as well as their ability to perform patient’s daily activities.

“We want more employees and we want to pay our employees,” said Cornett. “But we need the state to change the system so we can get more money into the payroll. And that will require a higher amount. “

Nursing homes warn that a heavy focus on staffing will overlook other important costs of running a facility safely. They say that even in the current reimbursement system, facilities are being destroyed.

“Not all expenses in a facility go to employees. Mark Johnson, an attorney for Brius Healthcare, one of the largest nursing chains: in California.

Whether lawmakers will sympathize with the industry’s plea for more money is questionable. They are increasingly demanding transparency about how skilled nursing facilities make and spend their money. Like hospitals and other health care providers, nursing facilities have received billions of dollars in federal covid relief funding to help offset the cost of hiring temporary workers. test and protective gear. Lawmakers have nothing to lose as this $12 billion industry is attracting more and more private investors to buy ownership stakes in their establishment.

“That tells me there’s money out there, profits out there,” said Wood, who also sits on the budget subcommittee that will consider the administration’s proposal. “Private equity isn’t going to go into the physical if they don’t have the opportunity to generate quite substantial returns.”

A lot is at stake for the roughly 400,000 residents of nursing homes in the state — and for the industry, which is a big spender and powerful force in Sacramento.

The California Association of Medical Facilities has contributed just over $2 million and spent $5.67 million lobbying legislators over the past 10 years, from January 1, 2011 to May 30. September 2021, according to a filing with the California secretary of state. office. And Cornett, its CEO, is a veteran of the state Capitol who served as top budget aide to four former Speakers of Congress and two Senate leaders.

During that time, California’s 50 largest individual and corporate nursing home owners and operators have given a total of $2.6 million directly to lawmakers, Republican political parties. and Democracy and Voting Measures. That number is likely to be a low number because it is difficult to identify everyone with an ownership stake in a nursing home or chain. The foundations are often partly owned by real estate investors, venture capital firms and other business interests not listed in government records.

Cornett has downplayed his industry influence and said trial attorneys are deep-pocketed and are funding patient advocates, an allegation the groups dispute.

But one 2018 Report of the California State Auditor found that the three largest private operators – Brius Healthcare, Plum Healthcare Group and Longwood Management Corp. – highly profitable. Their 2006 net income of $10 million grew from $35 million to $54 million in 2015, the most recent year the state auditor analyzed.

Patient advocates say those returns negate the industry’s argument for needing more tax dollars.

“To some extent, the state is shaken by the idea that the money they are paying now isn’t enough to do the work we asked them to do,” said Tony Chicotel, attorney for California Advocates for Cui said. Reform Home. “The bottom line is it’s going to be profitable.”

Methodology

KHN analyzed campaign finance records filed with the California secretary of state’s office between January 1, 2011 and September 30, 2021.

We downloaded contributions from the California Association of Medical Facilities, the organization that represents the industry in Sacramento.

To determine the number of nursing homes that have contributed directly to political campaigns, we identified the 50 largest individual and skilled nursing home owners in California using data compiled by the Centers for Disease Control and Prevention. Medicare & Medicaid Services announced. We connected those owners with nursing home chains and management companies that operate nursing homes.

We then searched each organization and individual on the secretary of state’s website to see if they had any political contributions. We didn’t include the money they gave to the California Association of Medical Facilities to make sure we didn’t double-count contributions.

To track lobbying, we created a spreadsheet of reported costs of lobbying disclosure forms from January 1, 2011 to September 30, 2021, which is also available on foreign minister. website, by the California Health Facilities Association. None of the nursing home companies we identified have spent money directly lobbying legislators. Instead, they gave money to the association.

Phillip Reese, an assistant professor of journalism at California State University-Sacramento, contributed to this report.

This story is produced by KHN, publish California Healthline, an editorially independent service of California Health Care Foundation.