老夫子传媒

At an emotional legislative hearing Tuesday, lawmakers and critics subjected the Newsom administration to blistering questions about the state鈥檚 oversight of nursing homes.

Assemblymember Jim Wood, a Santa Rosa Democrat who chairs the Assembly Health Committee, questioned the state鈥檚 lack of urgency in addressing licensing concerns.

鈥淲here is the proactive, patient centered, public safety approach here?鈥� he asked Cassie Dunham, an acting deputy director of the California Department of Public Health. 鈥淲here is that?

鈥淏ecause I don鈥檛 feel it right now. And yet here we are. Here we sit,鈥� he said. 鈥淲e have to wait for news articles. We have to wait for people to die.鈥�

Democratic Assemblymember Al Muratsuchi of Los Angeles, who introduced legislation earlier this year to address some of these issues, also grilled Dunham about the department鈥檚 performance in caring for California鈥檚 most vulnerable residents..

鈥淲hat I鈥檓 hearing is a lengthy history, that goes back decades, of the Department of Public Health failing to crack down on bad actors who are gaming the system,鈥� he said.

The tense hearing touched on the department鈥檚 staffing levels and on nursing homes鈥� financial practices, issues which elder care advocates and legislators have raised for years and have triggered similar hearings.

鈥淚 struggle to accept the premise that nursing homes are underfunded when their owners are living in homes that are sometimes worth $11 million dollars,鈥� said Kim Valentine, an Orange County attorney who has spent more than 20 years working on cases of elder abuse in nursing homes, in her testimony.

鈥淚 am petrified to get old,鈥� she added. 鈥淭his disgraceful, broken system of senior living care is something that we all need to care about. Because this is our future.鈥�

Two officials of the embattled department acknowledged that some changes are needed but attempted to deflect criticism by pointing to the stresses of the COVID-19 crisis, which hit nursing homes especially hard.

鈥淭hroughout the (pandemic) response, the department鈥檚 absolute focus has been on saving lives,鈥� said Dunham.

Much of the attention Tuesday was focused on longstanding licensing issues that CalMatters has documented extensively in recent months. The legislators repeatedly referenced reporting by CalMatters, which examined the state鈥檚 largest, for-profit nursing home owner, Shlomo Rechnitz of Los Angeles, and the unusual licensing decisions surrounding some of his homes. Lawmakers also cited work by KPCC and LAist, which looked at Crystal Solorzano, another controversial nursing home operator.

A CalMatters investigation published April 6 revealed an opaque state licensing process plagued. The report detailed how the state has permitted Rechnitz to operate facilities for years through a web of companies, despite license applications left in 鈥減ending鈥� status 鈥� and some that were formally denied.

A subsequent CalMatters story on Aug. 19 revealed that the department had for two homes whose applications actually had been undecided. After advocates pointed out that mistake to department officials, they doubled down, admitting the error but refusing to take the licenses away.

This week, CalMatters reported that family members of residents who died as a result of a COVID-19 outbreak at Windsor Redding last fall are suing that facility for elder neglect and abuse, alleging that employees were forced to come into work while symptomatic with the virus, and that dozens of residents who fell ill were left isolated and neglected due to 鈥�.鈥� The complaint specifically refers to Rechnitz and his management companies as being an of the skilled nursing facility, since the state denied them a license in 2016.

Mark Johnson, an attorney for Rechnitz and one of his companies, Brius, has in the past expressed frustration in emailed statements to CalMatters about the state鈥檚 inconsistent approach to Brius homes. Johnson also has previously said that the facilities in 鈥減ending鈥� status had licenses in good standing and were operated under an 鈥渋nterim management agreement,鈥� which he described as 鈥渟tate approved.鈥�

Tony Chicotel, a staff attorney at the California Advocates for Nursing Home Reform, referred to a 鈥渮ombie nursing home licensing system,鈥� which he described as 鈥渟traight bananas.鈥�

鈥淐orrosive (Department of Public Health) inaction has created a system where operators with terrible track records take over nursing homes without approval,鈥� he said. 鈥淲hat鈥檚 worse, when the state actually denies a license, it doesn鈥檛 really matter. The unfit operator can just keep operating.鈥�

California State Auditor Elaine Howle also called out the department for being inconsistent in its licensing practices at Tuesday鈥檚 hearing,

Muratsuchi referred to the Windsor Redding lawsuit repeatedly during the hearing, at one point asking Howle: 鈥淒oes it make sense to you that a nursing home can continue to operate when the owner鈥檚 application for a license has been denied five years ago?鈥�

Howle in 2018 published an audit criticizing state nursing home oversight, saying that licensing lapses by the California Department of Public Health increased the risk that residents may not receive adequate care.

In response to Muratsuchi鈥檚 question, Howle said: 鈥淚 don鈥檛 have that authority and that expertise. But if I had a loved one, I would be very concerned about having one of my family members in a facility like that. I would not do it.鈥�

Muratsuchi posed the same question to Dunham of the Department of Public Health, quizzing her on how it was possible that someone with a 鈥渄ocumented history of violations鈥� isn鈥檛 automatically barred from continuing to own and operate nursing homes in California.

The bill, where Tuesday鈥檚 hearing took place, and is not expected to be heard until next year. Wood, the committee chair, said in the spring that he believed the issue would require a lot of staff time to gather data and communicate with various state agencies, and that he wanted to make sure the California Department of Public Health and the Newsom administration were on board.

Craig Cornett, CEO and president of the California Association of Health Facilities, an industry group, said Tuesday that 鈥渟ubstantial improvements鈥� could be made in how the department handles licensing decisions. He expressed pride in the work of nursing home staff, especially in light of the pandemic, and said the state鈥檚 nursing homes are very highly ranked in many measures of quality. But he also noted that the industry faces 鈥渁 severe workforce shortage.鈥�

Cornett expressed frustration about long licensing delays and high licensing fees. But he said his organization opposed Muratsuchi鈥檚 bill as being punitive, 鈥渞ather than addressing the fundamental problems with the process.鈥�

The complaint against Windsor Redding lists 142 violations substantiated by investigators including neglect, abuse, staffing and infection control issues between January 2018 and June 2021. In November 2020, the federal government fined the facility as a result of the inspections.

In response to Muratsuchi鈥檚 question, Dunham echoed a response given to CalMatters earlier this year: Ownership applications are decided in a case by case, 鈥榩oint-in-time process,鈥� she explained, noting that applicants鈥� track records may change.

鈥淥perators may improve in their performance, operators may decline in their performance,鈥� she said.

Muratsuchi said it was clear that laws 鈥渄esperately need to be revised and changed.鈥�

His bill, , would forbid using management agreements to 鈥渃ircumvent state licensure requirements鈥� and would require owners and operators to get approval from the state Department of Public Health before acquiring, operating or managing a nursing home.

The Department of Public Health has a wide range of responsibilities surrounding nursing homes; its execution of several of those was criticized Tuesday. In addition to licensing, the department is responsible for routinely inspecting the state鈥檚 1,215 nursing homes to ensure they are meeting federal standards. It also conducts complaint investigations and can cite facilities for violating federal or state rules, and levy fines.

The hearing comes at a pivotal time. The industry is reckoning with the devastating impacts of the past 18 months, during which 9,243 California nursing home residents died of COVID-19, along with 249 healthcare workers. That data comes from the state鈥檚 Department of Public Health; some advocates and lawyers for nursing home residents say they suspect it is an undercount.

The department has been reticent to speak to CalMatters about licensing issues, refusing to put any officials on the phone. But at the hearing, legislators repeatedly called department officials to account.

鈥淐OVID cannot be an excuse to not do better,鈥� Wood said. 鈥淲e don鈥檛 need excuses. We have to do more.鈥�

 is a nonprofit, nonpartisan media venture explaining California policies and politics.