THE BAD - Black Boxes
CCLD started issuing Provider Information Notices (PINs) to its Adult and Senior Care Program Licensees on its website, with the first appearing on February 28. It did little more than remind facility owners of their existing Title 22 requirements - they had to report outbreaks in their facility to CCLD’s regional offices and to the local public health department. They also gave links to relevant websites (WHO, CDC, CDPH). As the PIN importantly noted, most of the websites they were referring to were intended for
health care facilities
, not non-medical ‘community care’ settings. Yes. That’s a problem.
CCLD’s PIN of March 6 rolled out its ‘emergency waiver authority’ citing the Governor’s Proclamation of a State Emergency. The Governor’s Stay-at-Home order went into effect on 19 March. The day before, however, the agency issued a six-page inventory of
blanket
waivers including many affecting the direct-care staff for the purpose of enabling “. . . staff to start caregiving immediately.” Waived were staffing ratios, staff training requirements for new staff, TB testing and staff age requirements. Oh yes, criminal records background clearance requirements (CBC) were also relaxed.
By 2 April, CCLD issued more sweeping waivers and changed the rules about facility-initiated closures. They included two attachments for noticing the responsible party of a person in care that CCLD had relaxed the criminal record background clearances for both facility caregivers and home care aides. The notice is nothing less than an ‘immunity waiver’ for providers and the agency for any harm befalling a resident attributable to the relaxed CBCs.
So in a matter of a few weeks, the CCLD managed to unilaterally roll back years’ worth of resident protections and safety requirements. And for what, and based on what metrics? It’s not clear to this writer that each of the blanket waivers is necessary or justified.
The effect of these waivers coupled with the stay-at-home order turned all RCFEs into black boxes – no family, no visitors, no ombudsman going in, and CCLD inspectors standing down. And because the state waived medical assessments for new admits, facilities can now take any resident, without regard to care needs.
My summary of a bad situation:
·
RCFEs turned into black boxes.
·
Sweeping and blanket waivers directly effecting resident safety.
·
An immunity waiver disclaiming resident harm resulting from relaxed CBCs.
·
A non-medical care model at risk of a facility outbreak of COVID-19, and
ill-equipped to respond to the medical emergency that
is
the pandemic.
So what’s been really happening inside assisted living facilities is anybody’s guess. Given the death rate in assisted living, some agency (maybe the local departments of public health?) should have been giving hands-on medical assistance to these non-medical congregate living venues with a strikingly similar demographic to skilled nursing.
It’s hard to know if the treatment and care of California’s assisted living and skilled nursing facility residents is just deeply-rooted ageism, or just run-of-the-mill state incompetence.
