Skilled Nursing Homes Under Scrutiny

The Inspector General and Auditor-Controller each released their initial report detailing their ongoing investigation into skilled nursing homes. Supervisor Mark Ridley-Thomas called it a critical first step towards improving operations at these facilities, which have accounted for about 42 percent of Los Angeles County’s COVID-19 death toll.

“We still have a lot of work to do, but the Inspector General and Auditor-Controller’s reports provide us with a starting point for tackling complex and deeply-entrenched problems that have plagued skilled nursing homes for decades,” said Supervisor Ridley-Thomas, who is scheduled tomorrow to bring 20,000 donated N95 masks, a decontamination kit, and mobile COVID-19 testing to skilled nursing homes and their employees. “We are undertaking the due diligence required to develop long-term solutions for improving quality of care at skilled nursing homes while simultaneously taking timely steps to promote the ongoing safety of both patients and staff.”

Overseen by the State of California but regulated locally by the County’s Department of Public Health (DPH), skilled nursing homes have been the epicenter of the pandemic in LA County, with about 16,000 infections and 2,500 deaths among patients and staff. In May, the Board of Supervisors approved Supervisor Ridley-Thomas and Chair Kathryn Barger’s motion directing LA County’s Inspector General to investigate skilled nursing homes for the first time. They also tasked LA County’s Auditor Controller with monitoring the facilities and creating a public dashboard showing their COVID-19 case totals, testing frequency, mitigation plan status, personal protective equipment supply and other information. The dashboard went live in September.

In his first interim report back to the Board, Inspector General Max Huntsman examined skilled nursing homes’ COVID-19 mitigation efforts and provided an overview of existing regulatory and oversight structures. He said subsequent reports will analyze the long-standing, complex issues that left many skilled nursing homes ill-prepared to prevent and control the rapid spread of COVID-19 and the systemic failures that have allowed substandard conditions to persist.

“My office is conducting an exhaustive review of barriers to adequate care that have, in many instances, left nursing home residents neglected and abused,” Inspector General Max Huntsman said. “Our County’s most vulnerable residents deserve better, and we are committed to identifying and recommending all reforms necessary to give them the care they need. The pandemic has exacerbated systemic problems, and we need immediate responses and long-term solutions.”

After posting the dashboard about skilled nursing homes in September, Auditor Controller Arlene Barrera released her own first interim report, which highlighted the number of outstanding investigations into skilled nursing facilities. She noted that in addition to 5,407 open investigations, DPH’s Health Facilities Inspection Division (HFID) reported an additional 6,228 in-progress investigations related to other long-term care and short-term care health care facilities.

The Auditor Controller also confirmed that as of June 30th, HFID reported 10% of the 5,407 in-progress investigations had been prioritized at the level of “Immediate Jeopardy,” because the facility’s alleged non-compliance with one or more requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

Upcoming reports by the Inspector General and Auditor Controller are expected to include recommendations for addressing this backlog and for streamlining the process.