Budget cuts to California senior programs during pandemic is ‘ageism,’ lawmaker charges

California lawmakers are questioning why Gov. Gavin Newsom has proposed cutting services for the elderly in this year’s budget at the same time the COVID-19 pandemic has devastated nursing homes throughout the state in an unprecedented medical crisis.

A joint hearing between the Health Committee and the Aging and Long-term Care Committee was convened Tuesday as COVID-19-related deaths in nursing homes more than doubled in May. Residents of nursing homes and long-term care facilities now account for about half of the total COVID-19-related deaths in California, public health data shows.

In his May revision of the 2020-2021 budget, Newsom has proposed cuts to home and community-based services, and Department of Aging programs that many seniors rely on, including the Ombudsman program that serves as an independent advocate for the elderly in nursing homes.

“The May revise is an example of ageism,” said Assemblyman Adrin Nazarian, D-Sherman Oaks and the chair of the Aging and Long-term Care Committee. “It unfairly balanced California’s budget on the shoulders of our frail, elderly, and disabled. It is a proposal that is unjust and unfair.”

Assemblyman Joaquin Arambula, D-Fresno, said he’s concerned about two services in particular: Community-Based Adult Services and the Multipurpose Senior Services Program, both of which would be eliminated on July 1 under the governor’s proposed state budget, saving about $410 million over two budget years.

CBAS, which includes health services, social services, and meals, currently serves 36,000 older adults and people with disabilities. More than half of those people are from communities of color, according to a fact sheet published by Justice in Aging. MSSP, which provides older adults who might otherwise be in nursing homes with the resources to stay in their homes and communities, serves 10,000 older adults.

For his part, Newsom has said he had to make difficult choices in the budget as the state faces an economic crisis. He said the budget funds our “most essential priorities – public health, public safety and public education.”

Nazarian pointed to the Little Hoover Commission’s report on Long-term Care in California from 1996. Twenty-four years later, many of the issues — underpaid health care workers, inconsistent oversight, and a lack of community-based alternatives for elders who wish to remain at home — remain problems in the state.

“We need to change the culture of ageism. If we are not using this time to demand change, then when?” said Nazarian.

“Perhaps in reflection, we can finally acknowledge COVID-19 didn’t cause these problems but dramatically revealed the shortcomings in California’s long term support services system,” Nazarian said.

At the hearing, state regulators, representatives of the nursing home industry, and nursing home reform advocates came together to discuss the crisis facing skilled nursing facilities. Speakers advocated for change in three key areas: financial support for elder care, improved health and safety oversight, and support for nursing home staff.

Kayla Shore, who works for Hand in Hand, a domestic employers network in Southern California, told the committee in a comment at the end of the hearing that pay for health care workers serving elderly populations needs to increase, and urged the state to hold nursing homes accountable. She finished with a request for the committees to attend to the budget.

“We also ask that you make budget cuts to police and prisons, not IHSS and critical programs for people with disabilities and older adults,” she said.

Focus on infection-prevention in nursing homes

It was clear from the hearing that California has been overwhelmed by the magnitude and scope of the COVID-19 crisis in nursing homes, even as it proposes substantial reforms to the industry that serves 400,000 elderly Californians.

Heidi Steinecker, deputy director of the Center for Health Care Quality at the California Department of Public Health, said the state has released over 60 pieces of guidance to nursing homes in the past three months on how to tackle the pandemic.

But guidance isn’t enough, said Steinecker.

Her department has proposed a six-strategy plan for reforming quality and safety oversight in California nursing homes.

The strategies include increasing testing, re-educating health care workers, and improving the infection prevention workforce, a part of nursing home care that has been lacking throughout the pandemic.

Every facility must have a full-time “infection preventionist” under the new plan, a significant shift for the many facilities that employ them only on a part-time basis.

As of now, nursing homes are monitored by a once-a-year Centers for Medicare and Medicaid Services certification survey. In the new plan, in addition to the once-a-year CMS survey, California would assign two or three facilities personally to each surveyor. Surveyors would then be involved with their facilities on a weekly basis — a level of involvement far beyond the current level of oversight.

The final two strategies in the oversight plan are the creation of a quality and safety oversight app to encourage the use of real-time data and a push towards predictive analytics.

“Licensing and certification across the nation tend to be a very reactive type of work,” said Steinecker. “You go in once a year on a schedule; you go in when there is a reaction to either a complaint or an incident.”

For the past few months, the CDPH has been collecting data and creating high-risk lists each day, to establish a predictive model for outbreaks, staffing issues, and infection control issues.

Long-term care Ombudsmen, who have been unable to enter nursing homes since March 13, usually provide a level of oversight that is now absent from facilities. Ombudsmen are generally aware of which facilities struggled to provide the expected standard of care before the pandemic began, said Leza Coleman, the Executive Director of the California Long-term Care Ombudsman Association.

“We need to get the Ombudsmans back in the building,” said Coleman, who specified that the return should be done thoughtfully, using the appropriate protective equipment.

The May revision of the 2020-2021 budget would reduce funding for the Long-term Care Ombudsman Program by $2 million.

Looking out for health care workers

Committee members were vocal about their concern for health care workers who serve elderly communities as well. According to data from the California Department of Public Health, almost 650 skilled nursing facilities have expressed intent to use staffing requirement waivers provided under the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers.

Leza Coleman said that many facility owners seek permission to utilize staff shortage waivers to get around addressing the real issue at hand: the lack of professional wages for health care workers in nursing homes.

“While care staff, by and large, are very caring, dedicated individuals, we can’t be so naive as to think they are working 60 to 80 hours a week in multiple facilities because they love what they do,” said Coleman. “They work these kinds of hours because that’s what’s required to cover the rent.”

And as health care workers in nursing homes are required to learn new skills in infection control and protocol, their pay should be increased anyway, said Arambula, the assemblyman from Fresno.

When the pandemic began, California nursing homes were provided a 10 percent reimbursement for long-term care per diem rates that will last until the end of the emergency period related to COVID-19. But it is unclear how much of that reimbursement has gone to health care workers.

Craig Cornett, the president and CEO of the California Association of Health Facilities, said that many facilities across the state have used reimbursements toward hazard pay, overtime, and wages for temporary workers. But much of that money has gone to procuring personal protective equipment, often at a high price.

“I’m thrilled to hear that facilities are paying hazard pay. But hazard pay needs to be all the time, not just when COVID is rampant,” said Coleman.

Coleman recommended to the committee that they should be careful not to vilify the nursing home industry. “We need to be flooding these facilities with resources, as well as holding them accountable for the care they’re mandated to provide,” Coleman said.

This story was originally published June 10, 2020 at 5:00 AM.