After pandemic hits nursing homes hard, California lawmakers push to tighten licensing rules

When Johanna Trenerry found a nursing home for her husband after his stroke, she expected his stay to be temporary.

He never came home.

Arthur Trenerry died at Windsor Redding Care Center in Northern California in October 2020. The 82-year-old great-grandfather is among more than 9,900 California nursing home residents who have died of COVID-19.

The nursing home where Trenerry died is state-licensed, but not under its current owner, Shlomo Rechnitz. The state denied Rechnitz a license, citing at least one death and multiple cases of “serious injuries” at other retirement homes he owns or operates. To circumvent this problem, Rechnitz formed a business partnership with one of the former owners of the house, who still holds the establishment’s license.

Some California lawmakers want to end these types of business arrangements and prohibit people or entities from buying or operating retirement homes unless they have a license — which most states do. They also propose an overhaul of the licensing process to reject applicants with poor performance and those who lack the experience or adequate financial resources.

The ambitious effort, which the industry sees as an overshoot, could make California’s surveillance the gold standard and a model for other states trying to improve nursing home care. Nationally, more than 152,000 nursing home residents have died from COVID during the pandemic, according to federal data.

“The public health emergency that we’ve been through could be something that becomes a catalyst for making real change,” said Dr. Debra Saliba, a UCLA professor of medicine who served on a committee of the National Academies of science, engineering and medicine which published a full report on nursing homes in April. “One of the things we have right now is the determination, the resources to make things happen.”

In his State of the Union address in March, President Joe Biden said the quality of care had declined at retirement homes taken over by investors — and pledged to set higher federal standards. Ahead of the speech, the White House released a proposal calling on Congress to increase funding for nursing home inspections and give federal regulators the power to deny Medicare funds to underperforming facilities. The administration also ordered the Centers for Medicare & Medicaid Services to come up with minimum staffing standards within a year.

States are also taking steps to improve quality. New Jersey, for example, passed a law this year that toughens penalties for health violations and requires nursing homes to disclose their financial records.

In California, lawmakers are considering several proposals, including changes to nursing home licensing rules.

Businesses and individuals can buy or manage retirement homes in California before obtaining a license, a process that even an industry lobbyist described at a legislative hearing this year as “backlogged” and unique to the country. ‘State.

“In California, owners and operators of retirement homes can operate without a license even after being denied a license,” said state Assemblyman Al Muratsuchi (D-Torrance), author of AB 1502. “Many of these owners and operators have, unfortunately, a long history of neglect and abuse.

Muratsuchi’s bill would require an owner or business to apply for a license 120 days before buying or operating a retirement home and would include financial records containing the names of all owners and investors. The state would reject applicants who do not meet standards of character, performance in other houses, and financial ability to run the house. Homes operating without a license would lose Medicaid funding and could not admit new residents.

The powerful California Health Facilities Association, which represents more than 800 nursing homes, blocked previous licensing legislation and set its sights on Muratsuchi’s bill. The group is led by Craig Cornett, a state Capitol veteran who has worked for four Assembly Speakers and two Senate leaders.

The organization made just over $2 million in political contributions and spent $5.9 million lobbying lawmakers from Jan. 1, 2011, to March 31, 2022, according to records filed with the secretary’s office. State of California.

The bill ignores the state’s ‘complex regulatory environments’ and would create ‘extensive’ disclosure requirements on property claims that ‘in many cases would fill an entire room with boxes and boxes of paper’ , Jennifer Snyder, a lobbyist for the association, told lawmakers in January.

The measure “would eliminate the ability for most current owners in California to apply for or even request a change of ownership,” she added.

But this year, the industry faces a changed political landscape.

COVID spurred lawmakers to act — and Muratsuchi won a valuable co-sponsor for his bill, Democratic state Assemblyman Jim Wood, head of the Assembly’s Health Committee. Wood condemned nursing homes for not doing enough during the pandemic and ordered state regulators to carry out stricter oversight.

Muratsuchi’s measure has been approved by the State Assembly and is awaiting a hearing in the Senate.

Investigations last year by news agencies CalMatters and LAist found that at least two unlicensed California nursing home operators operated dozens of facilities, even though officials from the State Department of Public Health State had declared them unfit to do so.

Homes remain open, in large part because it is incredibly difficult to find another nursing home for residents.

In July 2016, state regulators denied a license to Rechnitz — which had purchased Windsor Redding Care Center, where Arthur Trenerry died — citing 265 health and safety code violations at its other facilities over the past three previous years. Nonetheless, Rechnitz continues to operate the house in partnership with a former owner, Lee Samson, who is listed as a licensee in state records.

Mark Johnson, an attorney who represents Rechnitz and his company, Brius Healthcare, said Windsor Redding Care Center’s “license is in good standing” and that Rechnitz operates the facility under an agreement “which is customary in the skilled nursing facility industry”. Rechnitz has filed a new, updated license application with the state, Johnson said.

Johanna Trenerry said she had no idea Rechnitz was denied a license. If she had known, she says, she would never have placed her husband of 60 years in Windsor Redding.

Even before her husband caught COVID, Trenerry and her children were trying to move him to another house because he seemed overmedicated, couldn’t hold his head up and fell several times trying to get out of bed, a she declared. Once, she recalls, the nursing home let out the wrong person when visiting family.

They kept him “so drugged up,” said Nancy Hearden, one of the Trenerrys’ eight children. “And I think it was just because it was easier for them. He wasn’t going to go to rehab. I was like, ‘We have to get him out of here.’ »

Then he had COVID.

Sixty of the facility’s 84 residents contracted the disease in September 2020 – and at least two dozen of them have died. According to a lawsuit filed by family members of 15 deceased residents, including the Trenerrys, workers at the home were forced to work despite showing symptoms of COVID. The lawsuit cites state citations that found the home failed to provide enough personal protective equipment to staff members, failed to test staff, and placed COVID patients and untested patients in the same rooms with residents who were not infected.

Johnson denied the allegations.

This story was produced by KHN, which publishes California Healthline, an independent editorial service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.