The Los Angeles County Board of Supervisors unanimously voted Tuesday, May 26, to appoint an inspector general to oversee skilled nursing facilities, as nursing homes continue to suffer a huge toll from the coronavirus.
The action comes after Supervisors Mark Ridley-Thomas, District 2, and Board of Supervisors Chair Kathryn Barger, District 5, asked the board to appoint a watchdog to oversee such facilities, which account for more than half of all deaths from COVID-19 in Los Angeles County.
As of Monday, May 25, 1,085 people had died at institutional settings, most of them nursing homes — 7,238 residents had become infected and 3,376 staff workers at the homes had been infected. Total county deaths were at 2,116.
The impact on nursing homes across the county has prompted questions about how they were being regulated, and how vulnerable residents and staff wereat the sites.
The motion also called for bringing in the county’s auditor-controller to ensure closer monitoring of skilled nursing facilities immediately. The inspector general would be tasked with developing recommendations on how to strengthen oversight for skilled nursing facilities, and how to improve their operations long-term, according to a statement.
Many skilled nursing homes get low marks for quality of care, patient satisfaction, and employee pay, the statement noted.
“While we have been working quickly and tirelessly in some ways to expand testing and infection control our response has been stymied because many of these institutions, which are for profit, have been hindered by low standards, employee compensation and quality of care,” said Ridley-Thomas, who added that the problems have pre-existed the pandemic.
Barger said she has grown frustrated for what she perceived as a lack of urgency.
“Something we continue to identify but I don’t feel like there has been a sense of urgency to make sure it doesn’t spread beyond those facilities,” Barger said. “It seems to me early on we should have been more aggressive on that. But do this date I’m not sure we’re doing enough for testing at these facilities.”
Skilled nursing facilities, which serve thousands of residents who tend to be older and medically fragile, have become the focal point of L.A. County’s COVID-19 pandemic. Across L.A. County, 52 percent of all deaths from COVID-19 have been in institutional settings, particularly in skilled nursing facilities.
Jaime Garcia with the Hospital Association of Southern California said that skilled nursing facilities play a critical role in caring for patients recently released from a hospital. His association asked the inspector general to make sure nursing homes had testing plans that were fully operational and to help protect those facilities from punitive actions.
“Skilled nursing facilities are a major concern. Unfortunately nursing facilities have become the epicenter of the COVID-19 epidemic. Acute care hospitals are already seeing a reduced bed capacity and further reductions may delay hospital discharges,” Garcia said.
As of May 19, the county reported it conducted inspections at 200 skilled nursing facilities and was working to test residents at every single nursing home in the county but that process was still ongoing.
“This was really a look back several years to see which nursing homes had problems in the past. It was really a proactive visit, not meant to be responding to complaints,” Ferrer said last week. “Mostly we found that people were doing their very best and we gave some technical assistance. I don’t think there were a lot of violations.”
During the supervisor’s meeting Tuesday, Ferrer said she was not opposed to an outside auditor.
“At this point it’s all hands on deck,” Ferrer said. “In no way is this a reflection that they failed or have done something wrong. I think they’ve worked their hardest and done their best, but it hasn’t been enough.”
Ferrer did say, however, that cooperation among facilities has been an uneven experience.
“We have received great cooperation from some and not so great with others,” Ferrer said. “We feel like we are on the right track finally. We’re seeing the numbers come down but I do think this warrants close monitoring.”
“It is our collective responsibility to protect and support the most vulnerable among us,” said L.A. County Department of Health Services director Dr. Christina Ghaly. “Prioritizing the health and safety of those in our county’s skilled nursing facilities is the right thing to do and will also help protect the availability of hospital resources for all those who need them.”
The Ridley-Thomas/Barger motion says it is “critical that L.A. County learn the lessons of this crisis; identify the internal and external factors that have contributed to inadequate conditions within skilled nursing facilities; and provide oversight, accountability and resources as needed.”
Ferrer acknowledged that slowing the spread of the virus within nursing homes was hindered by medical unknowns early on. Up until early April, the department was unaware that asymptomatic people could spread the virus, so face masks were not required until that point.
Compared to the last week of April, when on average 170 deaths at nursing homes were occurring per week, the rate of deaths has gone down, according to Ferrer. In the last week of May, 60 deaths occurred at these facilities. she said.
The supervisors described the proposed inspector general as a ‘much-needed accountability measure” appointed to conduct an exhaustive review of L.A. County’s capacity to regulate skilled nursing facilities, recommend structural and operational changes and outline a plan for ensuring adequate and sustainable oversight. They also plan to task the inspector general with recommending regulatory and policy improvements at the local, state and federal levels to enhance quality of care, ensuring adequate infection control measures, and supporting healthcare workers.
To increase transparency, Ridley-Thomas and Barger also called for directing the L.A. County auditor-controller to take the lead in designing a publicly accessible dashboard with information about COVID-19 case totals, testing frequency, mitigation plan status, and other information. The motion seeks to find ways to enhance L.A. County’s ability to assess the adequacy of mitigation plans and to oversee their implementation.
Skilled nursing facilities have also received close attention from L.A. City government. Under an emergency order issued Friday by Mayor Eric Garcetti, skilled nursing facilities in Los Angeles will be required to provide diagnostic testing for COVID-19 for their employees, residents and contractors. The state too required Friday that all skilled nursing facilities do baseline testing of all its employees.
Garcetti said the facilities can request assistance with testing from the city’s Emergency Operations Center if they’re unable to obtain it themselves. The tests will be required to be administered at least once a month.
