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Sacramento Report: Enforcement Questions Loom Over Schools, Nursing Homes

A teacher at Lafayette Elementary School works with students as San Diego Unified begins phase one of its reopening plan at elementary schools. / Photo by Adriana Heldiz

An Assembly hearing Tuesday was designed to provide clarity on proposed guidelines for reopening schools across California. What legislators got was some lingering confusion about the rules and whether they can be enforced.

Assemblywoman Lorena Gonzalez and other members of an Assembly subcommittee on education finance asked California Department of Public Health and Department of Education officials to clarify their proposed guidelines. Stephanie Gregson, deputy superintendent for the state Department of Education, acknowledged that even when transmission rates are lower in local districts, the preparedness of school districts for in-person learning is heavily impacted by the lack of available resources to invest in proper precautionary measures. But Gregson applauded districts for using their resources for “creative solutions,” like outdoor lessons and installing plexiglass barriers, and recognized that the state can move forward with concrete actions like providing clarity around testing protocols, consistently tracking outbreaks and providing a steady revenue and supply stream to local districts.

Gonzalez was quick to point out that the California Legislative Analyst’s Office gave the Assembly a sample of state and local-level guidance that “might conflict with one another,” and emphasized that, because these are just guidance, there often isn’t anyone actually checking in with schools to make sure they are following the recommendations. In response, Deputy Analyst Edgar Cabral said that there are some specific requirements — like the use of masks and social distancing — for schools, but for the vast majority of school reopening details, the guidance is just that, and that schools can consider and implement it to the extent it’s possible. Gonzalez pressed state officials for clearer enforcement protocols, but others said they want flexibility.

Bill Simmons, president of the San Juan Teachers Association, said plans his district drafted for reopening over the summer are no longer viable due to changing health guidelines, state requirements and lessons learned from other school reopenings. He urged the state to “please consider creating guidelines for the educational process but avoid getting into the weeds.” Simmons said that with the versatility of a looser framework, districts were able to use local information to make decisions about reopening, rather than having to follow “one-size fits all regulations.”

Kara Grant

Staffing Concerns Still Plague Nursing Homes

María Carmen’s savings are dwindling. Still, she fears returning to work at a nursing home. The certified nursing assistant contracted COVID-19 earlier this year and soon after her family got the virus.

“I fear becoming infected again,” testified Carmen through a translator on Thursday during a state Assembly subcommittee [1] on nursing homes.

The wide-ranging discussion kept returning to nursing home workers. Many are women of color [2] who are poorly paid with little to no health benefits. To make ends meet, staff often work at multiple facilities, increasing the chances of the virus spreading. Longer term, a workforce shortage [3] in nursing homes is projected to worsen without major reforms.

“Anywhere, if the pay’s decent, people will come,” Assemblyman Jim Cooper said.

The nursing home industry – and a professor I spoke with [4] earlier this year –  maintain increased pay and staffing levels hinge on greater state Medicaid reimbursement, the lifeblood of the industry.

Dr. Michael Wasserman, a geriatrician and past president of the California Association of Long Term Care Medicine, questioned this premise. He said when it comes to business viability, for-profit nursing home operators focus too much on real estate and not enough on operations.

“The industry needs to take a hard look at how much money it wants to make and where it wants to make it,” Wasserman testified. He added that facilities ought to take a longer view: Invest more upfront in staffing to yield better care and eventually more savings.

Nicole Howell testified that besides boosting pay, the workforce needs to be supported in other ways. She’s the executive director of Ombudsman Services of Contra Costa, Solano and Alameda, which provides facility oversight, but also runs a 12-week program to train certified nursing assistants, complete with food, transportation and other wraparound services.

Heidi Steinecker, the deputy director of the California Department of Public Health, echoed that it’s not only about wages. She advocated for more programs to spark interest in the field, pointing to a European model [5] where university students live rent-free alongside elderly residents in exchange for helping at senior facilities.

Another subcommittee topic that came up a few times: nursing home enforcement.

In August, I reported that state regulators substantiated only 2.8 percent [6] of complaints against nursing homes during the first four months of the pandemic, dramatically lower than the same period the two years prior, leading to calls for stepped-up enforcement.

The article included comments from Rob Halliburton, who said it was difficult to get the California Department of Public Health to record his complaint against a San Diego nursing home.

The complaint was unsubstantiated, which Halliburton is appealing on his belief that regulators didn’t thoroughly investigate.

Steinecker, who was appointed to lead the California Department of Public Health in 2018, said progress against a complaint backlog stalled this spring when the agency shifted to infection control and personal protective equipment.

Steinecker said the agency has since reprioritized complaints, a process that’s now more efficient by pairing facility complaint investigations with COVID-19 mitigation surveys.  “We’re trying to reduce travel time,” she said.

Tony Chicotel, an attorney with California Advocates for Nursing Home Reform, told me in August that he was shocked at so few complaints being substantiated.

“There’s never been a more urgent time for enforcement, even zero-tolerance enforcement,” he said.

Jared Whitlock

Golden State News