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California attempts to overhaul its nursing home system


California’s nursing home system is an ongoing problem in search of solutions. While the controversy over their questionable quality of care during the worldwide pandemic made headlines, the state’s nursing home problems actually predate the spread of COVID-19.

The California Department of Public Health (CDPH) has a lengthy history of coming up short in regulating their nursing homes. In response, they have announced an overhaul – some would call it a retread – of their inspection program. They are proposing that CDPH inspectors serve in advisory roles, making multiple visits per month to counsel, educate, and provide technical assistance as needed.

Collaboration or conflicts of interest?

While the objective is to improve standards of care, nursing home advocates fear an adversarial and punitive environment. Inspectors who have advised nursing homes in the past may be reticent to provide full disclosure of their assessments. Those in support of the change see value in producing results in a more collaborative process with facility staff and management.

According to the California Advocates for Nursing Home Reform (CANHR), the average number of days to investigate complaints is 636 days, with Los Angeles County exceeding 1,000. The current number of active complaints to date is more than 13,000. By shifting, if not adding responsibilities instead of providing more staff and resources, that backlog will continue to grow.

The proposed change is anything but groundbreaking. During the 1970s and 1980s, a similar program of government inspectors to serve in partnership roles with nursing homes and regulators was implemented. However, it was abandoned after a 1986 study by the Institute of Medicine found that it negatively undermined quality care of residents.

After a bright, pandemic-driven spotlight over more than a year, the nursing home system in California is in desperate need of an overhaul, if only to build trust from family members who want the highest standards of care for their loved ones.