Senior housing

Aging in place helps you to avoid a retirement community or nursing home

By Senior housingNo Comments

“I’d like to move to a nursing home or assisted living,” said no older adult ever. In fact, a recent study by AARP found that nine of 10 older Americans preferred to live in their homes as long as possible. The aging-in-place movement seeks to let seniors do just that, avoiding heading to a retirement community or skilled nursing facility for as long as possible — or forever. But staying put requires planning, and the sooner you start, the more prepared you’ll be, whether you remain spry until 103.

There’s lots to do. You might start by remodeling or retrofitting your home to suit senior-specific issues such as decreased mobility or impaired eyesight (think improved lighting or replacing a bathtub with a walk-in shower). That’s what Arlington’s 78-year-old Stephen Grant did two years ago, adding a first-floor bedroom and bathroom and an outdoor ramp onto his Lyon Park bungalow. The interior spaces boast wider doorways (the better to potentially accommodate a wheelchair or walker), the bathroom has tricked-out grab bars and an easy-access shower. “I have some neuropathy issues, which means I’ll probably have an increasingly difficult time moving around in a few years,” he says. “I thought it was better to do this before it became a necessity. It’s given me a great sense of security.”

What Grant and others are buying into is also called universal design, meaning building or remodeling to accommodate all ages and abilities. It can usually be implemented or planned by builders or contractors who are Certified Aging in Place Specialist (CAPS), an educational designation offered by the National Association of Home Builders. “And it’s definitely more expensive to retrofit an existing property, though, so it’s helpful to think about doing things like an open shower or first-floor bedroom before you need them,” says CAPS-certified Clifton, Va., builder Vince Butler.

And even if you can’t do a major renovation or addition, simple changes like installing shower grab bars or amping up interior and exterior lighting can help ward off falls and other accidents. Both and AARP’s HomeFit Guide include room-by-room suggestions for making your home more appropriate for aging in place. Advice includes using floating vanity sinks in bathrooms (easier for someone in a wheelchair to use) and securing throw rugs to the floor with special two-sided tape to prevent slips. Checkbook’s aging-in-place advice is part of our ongoing series on issues affecting older adults that include estate planning and assisted living. You can read more (and more about Checkbook’s nonprofit, non-biased mission to help consumers) at

And for day-to-day needs, from laundry to transportation, you can get assistance from an elder village, an affordable social/medical network linking seniors with volunteers. The movement started in Boston’s Beacon Hill neighborhood in 2001, when a handful of older residents, concerned about staying in their homes as they aged, formed the country’s first village, a volunteer neighborhood group designed to provide social connections and practical assistance. The idea spread across the country, and there are now about 200 of these villages in the United States, with dozens more in development. For Checkbook’s database of existing villages, see Until Aug. 1, Washington Post readers have free access to Checkbook’s full aging-in-place report at

Villages operate under different models. Some are small and staffed by volunteers, who help with tasks like rides to doctor’s appointments, tree trimming and light chores. Others have paid stuff and include extensive social and wellness programming (French conversation classes, walking groups). Most villages charge small membership fees. All villages connect older adults to their neighbors and communities. “It’s a concept that’s really combating isolation,” says Barbara Hughes Sullivan, executive director of the Village to Village Network. “Villages get people out, even if it’s just to the grocery store.” also provides a directory of health agencies, resources for financial assistance, elder abuse prevention and legal help. It lists geriatric-care managers, consultants you can hire to help with planning, recruiting, supervision, and followup should you or a loved one need additional help staying in your home. It’s also a smart idea to contact local and national aging councils to learn about programs they offer. They can tell you whether you or a relative might be eligible for government benefits or assistance, and can usually help you with information on meal delivery, senior centers, low-cost in-home assistance, and help you navigate Medicare, Medicaid and other programs.

Since many seniors live by themselves, joining villages, taking yoga classes at the local rec center, or even getting a roommate can combat loneliness and keep them feeling connected and emotionally healthy. There are even online resources like the Elder Orphans Facebook Group and the Virtual Senior Center offering support and chat rooms.

Grant joined the Arlington Neighborhood Village a few years back seeking remodeling advice as well as rides to the doctor after an eye procedure. He’s driving again now, but village activities like potlucks and day trips keep him looped in.

And there are a range of other resources that can help you stay Chez You without endangering your physical or mental health. Besides the community-based food delivery from Meals on Wheels, you can get restaurant food or groceries zapped to your place by an ever-changing roster of services such as Uber Eats, Caviar and Peapod. Meal prep companies — Blue Apron, Hello Fresh and others — make it easier to put chow on the table without venturing out to the grocery store.

Today’s active-adult communities are stepping up their games

Because many seniors must give up their cars, public transit, ride-sharing and taxis become vital for getting around. Those with smartphones can use ride-hailing apps Lyft and Uber for offer convenient and inexpensive transportation. And there are free or subsidized public transportation passes for seniors, plus ride services to help fulfill medical appointments and other basic needs. In the Washington area, residents age 65 and older are eligible for Metrorail and bus discounts; they simply purchase a Senior SmarTrip card to ride Metro for half off peak fares or the bus for $1 a trip.

“There’s been a revolution in aging,” Sullivan says. “It used to be you grew old and moved into a retirement community or a nursing home. But people are staying in their homes and looking for more quality of life as they get older. They want choices.”

States Seek Nursing Home Alternatives

By Senior housingNo Comments

As Congress contemplates deep cuts in Medicaid, many states have come up with innovative ways to help elders remain at home during their twilight years, saving millions that otherwise would be spent on costly nursing home stays.

Medicaid — the federal program that provides medical assistance for poor and handicapped citizens — is biased in favor of institutional care. When seniors qualify financially and are deemed to require care, Medicaid funding for a nursing home bed is guaranteed. But if qualifying seniors want to receive care at home, they must request funding and wait for services to become available.

Institutional care is an entitlement under Medicaid; community-based care is optional. But it’s an option that experts say most people prefer. And it’s much cheaper. On average, community-based long-term care is about one-third the cost of comparable nursing home care.

Vermont is a leader in a nationwide effort to give elderly consumers the kind of care they want by balancing Medicaid spending between nursing homes and community services, based on consumer demand.

Joan Senecal, Vermont’s deputy commissioner for aging and independent living, says the state already is helping more than three times the number of seniors it was able to serve before federal officials agreed to remove onerous barriers to providing home-care options.
Two-thirds of nursing home patients are fully supported by Medicaid, with the remainder using personal money, private insurance and other funds to pay their bills.  The federal Medicare program for those over age 65 can be used to pay for drugs, doctor and hospital visits and some home medical services, but not nursing home stays.
In the mid-1970s, the federal government began loosening Medicaid rules to make it easier for states to shift spending to community services for the elderly. But many states were stymied by federal requirements that nursing home expenditures be cut before investments could be made in community services, such as assisted-living facilities, special transportation, home-health care and food services.
Oregon and Washington received special permission to invest Medicaid dollars in community-based long-term care in the late 1980s, and today their community programs are among the most developed in the country, with more than half of Medicaid expenditures going to community and home services.
Several other states have received community-care waivers since then, and many have made legislative commitments to developing alternatives to nursing home care.
But it’s not easy to make the transition, says Donna Folkemer, long-term-care policy expert with the National Conference of State Legislatures. “States have been working on the problem for a long time. What states have to do is reduce the institutional bed supply at the same time they create new home-care slots,” she explained.
Once community facilities are set up, states must work with elderly patients to coordinate their services and fill out reams of Medicaid forms to apply for funding. If home care isn’t arranged quickly enough, patients discharged from hospitals are immediately admitted to nursing homes, where Medicaid payment is guaranteed. More than half of nursing home patients come directly from hospitals.
Vermont received a first-of-a-kind exemption — or waiver — from Medicaid rules this year, allowing the aging department to pool funds for nursing home and community care, effectively eliminating the federal program’s bias toward nursing home care. It is the first program to allow elders, families and state caseworkers — not Medicaid regulations — to determine where a patient will receive care.
“Vermont has been able to say only those with the highest level of need are entitled to a nursing home and those with more moderate needs can opt for community care,” explained Susan Reinhard of Rutgers Center for State Health Policy.  The program allows the state to reach out to more seniors and provide preventative care that will keep them out of nursing homes, she said  “Lots of states are waiting in line to see if they can do the same thing,” according to Reinhard.
Through its program — Choice for Care  — Vermont has established a team of 12 nurses across the state to work with candidates for long-term Medicaid assistance. When elderly people become too frail to live on their own or are admitted to a hospital, nurses visit to determine the level of care needed and the preferences of the patients. Once a decision is made, patients either enter nursing homes or work with state caseworkers to arrange needed home services.
Sometimes it’s as simple as building a ramp and purchasing a wheelchair. Often it means providing funds so patients can hire caregivers, usually friends or family members, to help them maintain their daily lives.
“We knew we couldn’t make the waiver program work unless we had the staff in the field. We needed to know what their needs were so we wouldn’t overspend [on nursing homes],” Senecal said.  Vermont’s waiver requires the state to spend no more on its new program than it was spending under the old rules. The total long-term-care budget must follow the same trajectory — about 7.28 percent increase per year — that it followed over the last five years.
Other states want to move in the same direction. Kentucky’s aging authority has filed for a waiver similar to Vermont’s, and Georgia is expected to file for one soon.  Pennsylvania — with one of the biggest elder populations in the country and a large, established nursing home industry — also is considering a Vermont-style waiver.
Medicaid is the largest source of financing for long-term care for the elderly, accounting for about 30 percent of the nation’s spending on nursing homes. State Medicaid agencies allocate one-third of their budgets for long-term-care services, according to research by the federal Centers for Medicare & Medicaid Services (CMS).
Medicaid payments for nursing homes totaled $46.5 billion in 2004, and payments for home and community-based services totaled $15.9 billion in 2003, according to the most recent data available from the CMS.  Nursing homes receive more than 65 percent of their revenue from government sources.
With Medicaid expenditures amounting to some 20 percent of state budgets, solutions to expanding long-term care costs remain a top priority.
Pennsylvania’s aging department secretary, Nora Dowd Eisenhower, says consumer demand and budget realities are propelling the states’ shift to community-based long-term care.
“The boomers are aging. They’re sophisticated consumers that want to change the way long-term care is delivered. Governors across the country are challenged to come up with strategies for controlling the mounting fiscal burden of long-term care.  It’s going to happen,” Eisenhower said.

It’s Time to Abolish Nursing Homes

By Senior housingNo Comments

Albert P. died alone in a nursing home from Covid-19. because of new safety regulations, his daughter, Gita, was not allowed to visit. In the days before his death, she told me, the nursing home staffers “spoke to my mom at length about how great my dad was doing…. [They] said, ‘He’s eating. He’s drinking water. He’s smiling. He’s doing really well.’

Gita wasn’t so sure. She said there were previous issues with her father’s care: hours spent sitting in soiled bedsheets, medication mismanagement, and missed meals.

On May 6, a staff member called to tell her that Albert, 79, had died. She had never been told that her father was even ill. Then she was asked, “When are you going to come to claim the body?”

Gita remembered hanging up the phone. “I didn’t know what to do.”

Albert’s death was no outlier. More than 40 percent of Covid-19 deaths in the United States—about 62,000 people as of July 30—have been linked to long-term care facilities, according to the Centers for Disease Control and Prevention. About one in 37 nursing home residents have died of Covid-19. New York Governor Andrew Cuomo described the threat of the disease in nursing homes as “fire through dry grass.”

The rapid spread of infection in nursing homes isn’t new. Before the pandemic, 82 percent of nursing homes had citations for failure to adequately prevent or control the spread of infection; about half had multiple citations. Opportunistic infections by pathogens like Clostridium difficile thrive in nursing homes, and those usually caused by neglect, like sepsis and urinary tract infections, are prevalent. Covid-19 just spreads more easily and does its deadly work faster.

In New York magazine, music and architecture critic Justin Davidson recently imagined what it would take to build better nursing homes in the wake of Covid-19. Perhaps if we had smaller facilities or installed wet bars, people would like them better. He emphasized the need for more funding. But the problem with nursing homes is not that they need wood floors instead of vinyl or that food is served on plastic trays. The problem is that they are total institutions: secluded facilities where staffs tightly control the lives of vulnerable people.

There is some debate over the origin of the total institution as a concept, but it is usually credited to the sociologist Erving Goffman. In his 1961 book Asylums, he described total institutions as “an assault on the self.” In a nursing home, patients depend on and are at the mercy of the staff. Patients do not choose with whom they live or what activities they can do on a given day. It is, he wrote, entirely opposed to the way normal society functions.

Nursing homes allow for an economy of scale. Feeding, washing, and otherwise seeing to the needs of elderly and disabled residents all at once is more efficient than addressing those needs on an individual basis. But this efficiency comes at the expense of human dignity. Ari Ne’eman, a senior research associate at the Harvard Law School Project on Disability, points out, “From Grandpa Simpson to Junior Soprano, popular culture constantly acknowledges our society’s worst-kept secret: Nursing homes are awful places to live. Unfortunately, we’ve set up our health care and human services systems to send vast numbers of seniors and people with disabilities there anyway.”

That leaves us with a few basic questions: Why do nursing homes exist? How have they so thoroughly embedded themselves in the American life cycle? And what can we do instead?

Nursing homes are relatively new. Before the 20th century, all kinds of care—elder care and even surgery—were performed at home. The wealthy could hire servants to tend to the needs of their elderly relatives. Among those less well-off, women were expected to take on the bulk of the caregiving, uncompensated. And for those who were poor and without families capable of caring for them, there were almshouses.

Almshouses sheltered the “undeserving” poor: the disabled, the ill, children born out of wedlock, widows, and elderly people in poverty. Poorhouses were, for the most part, dilapidated and dirty and were seen as a last resort for human refuse. On Blackwell’s Island, now Roosevelt Island, in New York City hundreds of beds were squeezed so tightly together that the residents had difficulty getting in and out of them, according to Thomas Cole’s The Journey of Life: A Cultural History of Aging in America.

By the early 20th century, more specialized institutions opened to address the disparate needs of people who had relied on almshouses. These included schools for the blind and the deaf, orphanages, mental asylums, and homes for wounded veterans. As a result, the percentage of people in almshouses who were elderly soared. In 1880 about a third of almshouse residents were elderly; by 1923, that share of residents had doubled. In 1903 the New York City commissioner of charities announced that the almshouse on Blackwell’s Island would change its name to the Home for the Aged and Infirm.

The Great Depression overwhelmed and ultimately destroyed the almshouse system. Suddenly, millions of Americans were in poverty. This gentled public opinion toward the poor. The public turned against almshouses and embraced cash benefit programs. This shift culminated in the Social Security Act of 1935 and the advent of a federal welfare system. The act was meant to usher in an era in which senior citizens could pay to support themselves in their own homes.

To facilitate this goal, the legislation prohibited the use of federal funds for “an inmate of a public institution,” cutting off support for locally run almshouses. Unfortunately, it did not provide money for home health care or assistance with activities like feeding and washing. Private rest homes for the elderly stepped in to fill the void. Although it was supposed to end institutional care for senior citizens, the Social Security Act only refashioned it.

In 1960 amendments to the act radically increased nursing home funding. Between 1960 and 1965, federal spending on nursing homes ballooned from $47 million to $449 million a year. The advent of Medicaid in 1965 expanded nursing homes even further. Nursing home capacity more than doubled from 1963 to 1973.

Congress amended Medicaid in 1967 to include a definition of a skilled nursing facility and to require 24-hour nursing services and stricter building codes. Many of the smaller, older rest homes were unable to meet these new requirements, so larger, more hospital-like nursing homes took their place. But these more medicalized facilities weren’t much better. In order to turn a profit, many still spent as little as possible on residents. In his 1980 book Unloving Care: The Nursing Home Tragedy, Bruce Vladeck describes post-reform nursing homes “with green meat and maggots in the kitchen, narcotics in unlocked cabinets, and disconnected sprinklers in nonfire-resistant structures.”

In 1981, Congress amended the Social Security Act to allow for home- and community-based services waivers. Before that, seniors and disabled people could get comprehensive long-term care only in institutional settings like nursing homes; if they remained at home and wanted such care, they had to pay for it out of pocket. The new HCBS waivers allowed Medicaid to fund comprehensive care at home.

Even though three out of four people over the age of 50 want to remain in their homes, according to a 2018 AARP survey, the system remains weighted toward nursing homes and other forms of institutional care. Despite scandal after scandal and reform cycle after reform cycle, federal spending on nursing homes was $57 billion in 2016. The American Health Care Association, the largest lobbying group for the industry, spent $3.84 million in 2019 in its push to further loosen safety regulations and reduce the industry’s legal liability. And the resulting solution to lawsuits over poor conditions? In July, President Donald Trump announced $5 billion in additional funds.

Technically, all seniors who meet the financial criteria should have access to home care through Medicaid. But despite legal requirements, seniors and families are rarely informed of this option. Jennifer Goldberg, the deputy director of Justice in Aging, pointed out that “far too often, hospitals and nursing homes don’t tell older adults how they can get the care they need in their homes and communities.”

In 2017, when Albert first entered the nursing home, it was meant to be a temporary stay for rehabilitation, with the cost covered by Medicare. He had experienced some kidney trouble. A nursing home, according to Gita, was the only option given.

Initially, Albert seemed to be doing well. But days before he was supposed to be discharged, he contracted a C. difficile infection, which can be deadly and is spread mostly in hospitals and nursing homes. his health declined rapidly. He lost a dangerous amount of weight, and it became clear that he would not be returning home within the time allotted by Medicare. Then he came down with pneumonia. Eventually, he also developed contractures—painful tightening of the tendons and joints from months of disuse. He bounced from nursing home to hospital to nursing home. And at no point, according to his daughter, was his family offered an alternative.

“Had staying at home been an option, I don’t think we would have ever put him in a nursing home,” Gita said.

According to the Kaiser Family Foundation, nearly three-quarters of national long-term services and support spending for seniors goes to institutions like nursing homes. Nursing homes are an entitlement, which means seniors have immediate access to them through Medicaid. Home care, on the other hand, has waiting lists. In 2017 there were 201,000 seniors and adults with physical disabilities waiting for Medicaid-funded home care. Nationally, the average wait for an HCBS waiver is two and a half years.

Why do waiting lists exist for a service delivery model clearly preferred by most Americans? And why wouldn’t case managers tell seniors about all of their options? Nicole Jorwic, the senior director for public policy at the Arc of the United States, a part of the Disability and Aging Collaborative, gave one possible explanation. “If a case manager is talking about discharge options for an individual, [an HCBS waiver] waiting list may last longer than the individual may live,” she said.

Another barrier to the wider adoption of home care in the United States is that nursing home associations and unions lobby against it. The associations’ reasons are self-evident: They are protecting their business interests. Trade unions have historically opposed home care because home care workers are less likely to be unionized. In general, they also have lower pay and less job security. Even with home care workers unionizing in recent years, the pay remains low and the hours long. Most of these workers are immigrants and women of color, and the turnover is immense: Every year, two-thirds of home care workers quit.

In order to expand and improve home care, workers need higher pay, better benefits, and more job security. In short, they need to be treated as the essential workers they are.

Then there are the more literal, physical barriers to home care. Stairs and bathtubs can become unusable for elderly residents. Carpets and coffee tables can be deadly hazards. There is a shortage of accessible housing in America. This problem, at least, has a straightforward solution: Pay to make existing housing accessible. The Community Aging in Place–Advancing Better Living for Elders (CAPABLE) initiative at the John Hopkins School of Nursing piloted a successful home-based intervention a decade ago, and the program has been expanded. A registered nurse, an occupational therapist, and a construction worker meet with a senior at home, evaluate the person’s needs, and renovate the home for accessibility. According to CAPABLE, every $1 spent on the program yields nearly $7 in savings.

But what about seniors with severe disabilities like dementia? Many people think it is impossible for a person with dementia to live safely outside a locked facility. Jorwic, whose organization represents many Americans with significant cognitive disabilities, disputes that.

“When it comes to serving individuals with dementia, it can be really difficult for families, service providers, and staff to see how that person can live outside of a [nursing home], and it is important to note that the same security can be done in a home- and community-based setting,” she said.

The idea that anyone can live independently given the right supports is prevalent in discussions about disability but less common in ones about aging. Appropriate staffing is key: People with more significant disabilities may need more staff to assist them in their everyday lives.

The idea of a greatly expanded home care workforce and widely available individualized care brings up the issue of cost. According to the National Council on Disability, an independent federal agency, home- and community-based services have proved to be significantly less expensive than institutional care in every state that tracks the data. But the current level of home care is not always sufficient to meet an individual’s needs. Costs are held low by Medicaid reimbursement caps, the exploitation of home care workers, and red tape: Navigating Medicaid home and community-based services can be a Kafkaesque nightmare. People sometimes die before they’re able to access adequate care.

Finally, there is the prevailing cultural idea that nursing homes are inevitable: We are born, we work, we retire, we go to a nursing home, we die. But there is nothing inevitable about nursing homes.

Through his work in disability rights, Kelly Buckland, the executive director of the National Council on Independent Living, has been championing ways to end the nursing home model for the past 30 years. Oddly, many people who support community living for younger disabled people still think of nursing homes as necessary for seniors.

“There’s this underlying belief that when you get old, that’s where you go,” Buckland said. “But no one goes to a nursing home because they’re old. They go there because they have a disability.” He and other disability rights advocates envision a world with home care for everyone: no more institutions. To some, it may seem like an absurd dream, but all we need is the political will to make it happen.

It’s Time To Retire Nursing Homes

By Senior housingNo Comments

I read an article recently that dealt with the question of why nursing homes cost so much and the difference between for-profit and not-for-profit nursing homes. This legitimate question had been the basis of solid research by the Michigan Retirement and Disability Research Center at the University of Michigan and financed through a grant from the U.S. Social Security Administration. The article itself was on the “Squared Away Blog,” published by the Center for Retirement Research of Boston College.

I mention all of the above because it seems like an arcane question in a world where we are about ready to bid farewell to the whole concept of a nursing home. Today we have at least three options for those who need some level of care that they cannot provide for themselves: skilled nursing facilities (SNF), nursing homes, and assisted living facilities (AL). Here’s how they differ:

Skilled nursing facilities look a lot like hospitals. They are sometimes referred to as rehabilitation hospitals or acute care facilities. They are very institutional in look and feel and may even be part of a hospital. In addition to meals, SNFs provide medically necessary professional services from nurses, physical and occupational therapists, speech pathologists, and other medically trained personnel. They are staffed 24 hours a day and they have a licensed physician that supervises the care of all residents. They are used not only by older adults, but by people of all ages who have had surgery or are recovering from an accident and need temporary round-the-clock care.

Nursing homes provide a somewhat less institutional feel and cater to those who need a lot of help with the activities of daily living (bathing, dressing, toileting, grooming, eating, mobility) in addition to their meals. They also manage medications, take care of residents’ laundry and transport residents to doctor appointments.

Assisted living facilities cater to residents who need help with some of the activities of daily living (ADLs), provides all meals, helps with transportation, and provide a variety of activities for residents to engage in (exercise, crafts, games, etc.). Argentum, the national association that serves the assisted living industry, describes AL as a “combination housing, personalized support services and health (not medical) care, designed to meet the needs of those who need help with ADLs.

The whole concept of “assisted living” arose in the mid-1980s and took off like a rocket, because it filled a large and obvious need. It was originally conceived as a way of bridging the gap between skilled nursing facilities, with their heavily institutional feel, and recuperating at home with minimal help with ADLs, especially for people who had no one living at home with them. From their inception, assisted living facilities have focused on having a more home-like, non-institutional feel. By the mid-1990s there were hundreds of retirement residences billing themselves as “assisted living.”

Today there are over 28,000 assisted living residences in the U.S. and though they vary quite a bit in what they offer, there can be no doubt that AL has moved well into the territory of the more archaic nursing home and has rendered it redundant. Most AL facilities are bright and colorful, they offer residents many opportunities to carry on their lives as independently as possible. Rather than hospital-like rooms, residents live in individual one-bedroom or studio apartments, have their own bathrooms, take their meals in a dining room where they can sit where they wish and socialize with friends; some even maintain their own vehicles and transport themselves to shopping and appointments when they feel up to it.

My 96-year old cousin is living in AL. She went in at age 89, and was able to manage her own personal hygiene and most other ADLs. However, as she has gotten older, she needs more help and the facility she is in provides it on an a la carte (fee) basis, as she requires it. Today she no longer manages her own medications because she has lost almost all of her eyesight, and she needs help with dressing because of increasingly painful arthritis, but she is still able to transfer herself from walker to bed and from bed to the toilet. She still goes down to the dining room to eat and enjoys chatting with other residents and the staff.  She is a good example of the trajectory of aging most often seen in assisted living communities. When she needs medical care, she is transported to a nearby hospital, then comes home to her apartment in AL to recuperate.

Assisted living has become an industry in and of itself. At senior housing industry conferences, no one talks about nursing homes. They are a relic of another age and it’s time for the term to be retired once and for all.  As for skilled nursing facilities, we should all strive to stay out of them as much as possible. They are not pleasant places to be and cost an alarming amount of money. They are strictly for people who need 24/7 medical care and even at age 100, most people do not need that level of medical care. They need help with ADLs and do just fine with home care or assisted living.

Coronavirus: Nursing home deaths spike in O.C., prompting calls for more action

By Senior housingNo Comments

While Orange County Public Health Officer Nichole Quick said the county is doing everything possible to contain the burgeoning number of COVID-19 cases and deaths in nursing homes, advocates for the elderly are calling for more ardent efforts and ask that the county emulate steps taken in other places with large, vulnerable populations.

On Wednesday and Thursday, 18 of the 24 coronavirus deaths in county struck residents of nursing homes and other long-term care facilities, according to county data. By Friday, the county was reporting a total of 118 deaths, with nursing home residents accounting for 45.

Nursing home residents make up less than 1% of the state’s population, according to a recent report by the Public Policy Institute of California.

But nursing homes and other long-term care facilities account for a far larger share of the county’s COVID-19 cases and deaths, with those percentages growing weekly.

At the end of April, long-term care residents and staff accounted for 14% of all county infections. They now account for 19%. And at April’s end, those residents accounted for 27% of all county coronavirus deaths, a share that had reached 38% by Friday. There’s been a single related staff death, according to county data.

“Please know that we are doing everything we can,” Quick said of nursing home infections at a press teleconference Thursday.

She listed a number of initiatives the county has undertaken to stem the rising number of nursing home infections and deaths, including a team of “infection preventionists who conduct an on-site assessment within 24 to 48 hours for any facility that has more than one resident testing positive for COVID-19.”

Additionally, the county has contracted with nursing registries to help fill staffing gaps at the facilities, has established an ambulance strike team for potential evacuations and has taken several other steps to support efforts at long-term care facilities, Quick said.

But while nursing home advocates applaud any improvements, they say far more needs to be done. That’s particularly true given the spiking numbers in Orange County, where there are now at least 21 facilities in the county with outbreaks — defined as more than one infected resident — up from nine at the end of April.

“We’re going to continue to see this kind of pace of infections and deaths for a few months,” said Michael Dark, an attorney for California Advocates for Nursing Home Reform. “We still haven’t started comprehensive testing of every resident and staff member. And until we do, we’re not going to know the extent of the problem.”

Fixing the problem

While long-term care facilities tend to be densely populated by older people vulnerable to illness, that doesn’t mean they’re predestined to be hot beds of COVID-19 infection, according to Dark.

“At community acute-care hospitals, there are a lot of infected people but you don’t see the same rate of spread,” he said. “The problem in nursing homes is poor infection control and understaffing. You can have a nursing assistant see 10 or 15 residents an hour. It’s hard to take proper infection control measures at that pace.”

As for testing patients and staff at nursing homes, some counties have been more aggressive than Orange County.

By the end of April, Orange County had begun testing all residents at any nursing home that had two or more infections among residents. It offered voluntary testing to staff that wanted it.

But by the time Orange County began mandatory resident testing, Los Angeles County was already underway with a more stringent policy requiring testing of all residents and staff at any long-term care facility with a single infection.

While Dark wants to see mandatory testing of all residents and staff at all long-term care facilities — even where there are no known infections — he said at very least, a single positive test should trigger mandatory testing of all residents and staff at a facility.

“There’s no such thing as a single resident infection,” he said. “They either got it from another resident or from a staff member.”

He noted that visitors, including family members, have been largely banned from nursing homes since the start of the pandemic.

Libby Anderson of the Council on Aging, who serves as ombudsman to nursing home residents in Orange County, also is pushing for universal testing of everyone in the facilities.

“If you have one infected staff member who’s asymptomatic, they can infect one resident after another,” she said.

Help on the way

Statewide, the percentage of COVID-19 deaths in long-term care facilities is even greater than in Orange County, at nearly 50%. But Orange County’s rates are increasingly more rapidly than those statewide.

Helping in efforts to slow the spread of infections in nursing homes is a joint collaboration between UC Irvine and CalOptima, which provides health-care services for the indigent. The effort is being led by Susan Huang, medical director of the UCI Health Epidemiology and Infection Prevention program, and funded with $629,000 each from CalOptima and the county Health Care Agency.

The program is focusing on infection prevention training at 12 county nursing homes that have high numbers of CalOptima patients. It also will develop a training program for 55 other nursing homes. The year-long intensive training began on May 8 and is underway at three facilities so far, with three more about to begin.

“The actual viral outbreaks in nursing homes are being addressed by a (Health Care Agency) response team,” said Emily Fonda, CalOptima’s deputy chief medical officer. “The OC Nursing Home COVID Prevention Program is a separate effort directed at training staff to manage current outbreaks and the expected resurgence of the virus in the fall.”

California nursing homes are examples of how cruel the coronavirus pandemic can be

By Senior housingNo Comments

DINUBA, Calif. — The gravesite still has no marker.

No grass has grown over the dry ground here, in a flat cemetery surrounded by some of the richest citrus groves in the country, where Hortensia Sosa and her husband, Luis, are buried together.

The grave is too new for that. Just dug. Just filled.

After she died of the novel coronavirus last month, Sosa’s body was kept for 10 days in quarantine. At first, family members were not allowed to leave their cars during her burial. They finally received permission to do so, but only if they stood well away from the tiny patch of ground as Hortensia’s coffin was lowered slowly on top of Luis’s casket.

“There was no rosary, no Mass,” said Olivia Lopez, the oldest of the couple’s three children. Her only contact with her 92-year-old mother in the final months of her life was through FaceTime. “I could see for two weeks how badly she was deteriorating just over the phone. But I couldn’t help her. I felt like my hands were tied.”

Sosa is among the 1,058 residents of skilled-nursing facilities who have died in California as of this week as a result of the coronavirus, a quickly escalating toll that accounts for about 40 percent of the state’s deaths from covid-19, the disease caused by the virus. While that data is reported by a majority of the state’s registered nursing homes, the total number of such deaths is probably far higher. Such homes have reported 6,250 infected residents, who because of underlying health afflictions and living in close quarters are particularly susceptible to the virus.

The disease also has ravaged front-line workers at skilled-nursing homes, the majority of whom earn little more than minimum wage. According to state public health statistics, at least 23 nursing-home workers have died of covid-19 and more than 3,600 others have been infected.

Such homes have proved to be the most vulnerable of the state’s health-care facilities and are examples of the dangers seen nationwide, from the first crush of cases and deaths in a nursing home in Washington state in late February to the widening nationwide crisis afflicting the elderly and those caring for them.

Three months since the novel coronavirus hit the United States, regulators still have few ideas for how to protect the uninfected, especially in nursing homes. And a shortage of protective equipment, cramped facilities and understaffing — due in part to the loss of workers who fall ill because of the virus — set the facilities up for tragedy and has made them the cruelest venues of this pandemic.

Workers at the Redwood Springs Healthcare Center in Visalia, Calif., listen to the prayers of well-wishers during a break outside the nursing home early this month. (Melina Mara/The Washington Post)

In New York state, there have been more than 2,800 confirmed deaths of nursing-home residents related to the virus. In Minnesota, 47 residents died in a suburban Minneapolis nursing home two weeks ago. No state is immune. Earlier this week, 14 residents of a nursing home in Stanislaus County died of the virus, among the largest single outbreaks in Northern California.

The death toll is so high in California’s nursing homes — including 27 other residents who died along with Hortensia Sosa in the Redwood Springs Healthcare Center in nearby Visalia — that privately run nursing facilities are seeking immunity from lawsuits once the virus passes. Gov. Gavin Newsom (D) has yet to comment on the request, which is ardently opposed by advocates for the elderly. The staff of New York Gov. Andrew M. Cuomo (D) inserted a similar immunity provision for nursing homes and hospitals in the state budget.

At the same time, state health officials are trying to free up hospital beds, offering nursing homes, many of them severely understaffed, up to $1,000 a day to take less serious coronavirus patients. That proposal, too, runs counter to the care that advocates say the elderly should receive.

“We’re really not yet even seeing the epic scope of this in this state’s nursing homes,” said Mike Dark, a staff attorney for the nonprofit California Advocates for Nursing Home Reform (CANHR) who calls the death and infection rates being reported to the state “tremendously unreliable.” “When we look back on this in 10 years, we will view it as more than anything a plague on the nursing homes.”

Job-jumping, little testing

There are more than 1,100 licensed nursing facilities in California, and according to the 83 percent of them reporting to the state right now, 6,600 residents are infected with the coronavirus. All have been closed to visitors — family or otherwise.

State regulations say that those infected should be quarantined within the building and that infected residents are to be cared for at the nursing home for as long as possible, keeping them away from hospitals.

“For a lot of these seniors, they are really isolated in there, and that is also not good for anyone’s health, especially if you already have other conditions,” said Long Beach Mayor Robert Garcia, who estimates that a majority of his city’s 27 deaths have come within nursing homes. “It’s really sad to see.”

Nearly every care home is looking to add staffers. A banner hanging above the Brighton Care Center in Pasadena, where dozens of residents have been infected, advertises a “sign-on bonus” for front-line workers. All shifts, the banner notes, are available.

Pasadena, a relatively wealthy city northeast of downtown Los Angeles, has 16 skilled-nursing facilities, all in proximity. That means the job-jumping that many care workers do to make ends meet in an expensive area creates exposure and spread concerns.

On April 12, Pasadena issued a health order that states that “facilities should avoid, by any means possible, utilizing employees who have worked at another facility.” Other cities have done the same.

Of Pasadena’s 28 coronavirus deaths reported by the last week of April, all had come from within care homes.

“Nobody has prioritized testing for people in skilled nursing, and so what happens is people are unknowingly spreading the virus from building to building, many because they don’t know if they’re asymptomatic,” said Deborah Pacyna, director of communications for the nonprofit California Association of Health Facilities, which represents about 900 skilled-nursing homes in the state. She said having jobs in multiple facilities is a “common practice” in the industry. “Our caregivers are exceptional people, and it’s true that they are not getting paid enough.”

In Antioch, a city in California’s East Bay, where a number of nursing homes have seen outbreaks, the Lone Tree Convalescent Hospital has recorded zero coronavirus infections among nearly 100 patients and staffers. Phylene Sunga, the administrator, put stringent “infection control” rules in place very quickly after the virus began to flourish and stepped up the care home’s cleaning routine.

The staff quadrupled the times “high touch” areas are disinfected each day. Nine staff members work at other care homes, as well. But before coming to Lone Tree they must change their clothes and shoes and wash as much as possible. One staff member who was infected at another care home was taken out of the rotation at Lone Tree.

“I told her not to come back, it wasn’t worth it,” said Sunga, assuring that the job is waiting for her when she recovers. “It’s working — so far.”

A thinning staff

Lisa Cook sent a catered barbecue dinner to the front-line workers at the Stoney Point Healthcare Center in Chatsworth, a valley town in northern Los Angeles County, to show her appreciation for the care they have given to Bruce, her husband of more than three decades.

Bruce and Lisa, high school sweethearts, were senior managers at a baby-supply store called the Juvenile Shop, working there together until Bruce suffered a stroke in December 2018. He was just 60 years old and lost function of much of the right side of his body.

Lisa Cook’s travels through a complex, expensive health-care system began — a trail well marked by the piles of legal documents, letters to and from hospitals, and legal pads of research that sit along the fireplace of her Northridge home. There is a box of rubber gloves on the kitchen table, a mask nearby.

Last fall, Bruce ended up at Stoney Point Healthcare, a 110-bed care facility about a half-hour drive away. The two could communicate through FaceTime, though Bruce needed help from an orderly to push the right iPhone buttons.

“I felt like he was getting really good care,” Cook said. “It was when this covid-19 thing hit that it got out of control.”

The biggest loss, immediately, was access to Bruce. Cook got a call from the administrator on the morning of March 14 telling her she would no longer be able to visit, because the care home was in lockdown.

Workers started to get sick — more than two dozen have been infected in recent weeks, five of whom have recovered and returned to their jobs.

“We see now who really matters in this country, who really makes it work,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “People who stock the grocery shelves, the people who are delivering the mail, the people who are picking up the garbage — those are the people that matter.”

As the Stoney Point staff dwindled, Cook had almost no way to check on her husband. He had not been infected, but had he been placed in a safe room, away from those who had the virus? Was the TV she bought him hooked up if he had been moved?

“So many of these places have become more like warehouses and less like health-care facilities,” said Dark, of CANHR. “As you lose staff, your infection control goes out the window. But traditionally if you get a citation here, it was always just the cost of doing business.”

Pacyna, the spokeswoman for the state’s skilled-nursing homes, said she would like to see some of the large venues that some cities have opened as emergency hospitals to be used to help separate noninfected patients such as Bruce Cook from those with the coronavirus.

Los Angeles County, for example, turned its large convention center into a field hospital, which has been only lightly used. Neither the convention center nor the USNS Mercy, the 1,000-bed Navy hospital ship deployed to the Port of Los Angeles, takes coronavirus patients.

“What you’re doing now is trying to create an area or a space where you can accommodate everybody,” Pacyna said. “But you’ve been in these buildings: They’re old, they’re small. Many were built in the 1950s. We’re just pushing right now for more creative alternate ways to protect these people.”

As of last week, six Stoney Point residents had died of covid-19. Under the testing rules in place at Stoney Point, and in other care homes across the state, patients are tested only if they show symptoms or if they choose to be.

“His care just appears to have deteriorated so quickly,” Lisa Cook said. “We know people are dying in this facility, and we just can’t get any information.”

In a statement, Stoney Point administrator Timothy Mason pledged to “evaluate all protocols and procedures from this pandemic in the not-too-distant future to see how we can improve upon all aspects of our communications with family members, patients, and staff.”

Waiting too long

The cluster of roses in the wide vase on top of Hortensia and Luis Sosa’s grave are from Olivia Lopez’s garden. She changes them a few times a week. And on a bright Sunday, the grassy cemetery attracting only a few families, a brother and sister talked about what the carved stone on their parents’ grave might say.

“It has to mention her laugh,” said Joseph Sosa, a mental health counselor for troubled youths, recalling that he could hear it blocks away walking home from school.

“Everyone has some thoughts,” said Olivia Lopez, his big sister. “So we’ll have to get a lot of opinions.”

Luis, who picked grapes in the San Joaquin Valley his whole working life, died in the Redwood Springs home in Visalia just before Christmas.

He was 92 and in poor health, but Olivia Lopez was unhappy with the care he received toward the end of his life. She wanted to move him into another care home. As the coronavirus began to emerge, though, there were no beds available nearby.

Her mother had checked into Redwood Springs with him in April 2019 — also 92 and suffering from dementia.

The mother and daughter FaceTimed almost daily, but in late March, after Hortensia was diagnosed with the coronavirus, she visibly weakened. Officials from Redwood Springs told Lopez to put her mom in hospice care, essentially to wait out her death.

Instead, Lopez demanded that her mother be admitted to a hospital. She received a call the following day from Redwood Springs, telling her an ambulance was on the way to get her mother and take her to Kaweah Delta Medical Center. Lopez met here there, still sealed off from actually seeing her.

“The doctor looked at me and said, ‘What took you so long to bring her here?’ ” Lopez said. She added that a nurse echoed those comments later the same day.

The next day — April 10, Good Friday — Hortensia Sosa died. Lopez discouraged friends and family from attending the viewing, where only 10 at a time would be allowed to see her mother, encased in a coffin and placed safely beneath a plexiglass dome to seal off the possibility of infection. There were few at the burial, and no reception followed.

“We will, though, we will have a Mass right here in town when this is over,” Lopez said.

In a statement, Redwood Springs administrator Anita Hubbard said the company has been vigilant and was an early adopter of local, state and federal guidance for the care of the frail and vulnerable residents in their care.

“This incident underscores the service and sacrifices made by our dedicated team every day,” Hubbard said. “We’re grateful for their continued efforts. Our top priority remains the health and well-being of everyone in our facility.”

The complex is festooned now with purple-and-white banners and yard signs that read “Heroes Work Here.” The public has expressed almost unequivocal support for the nursing and orderly staffs at even the most virus-plagued care homes, including Redwood Springs.

But the Lopez family has another worry ahead.

Lopez’s husband, Richard, has a brother in another care home where the coronavirus has broken out. Porter Lopez is 79 years old and suffers from Parkinson’s.

“There’s not much we can do,” said Richard Lopez, a retired county probation officer. “We’re just praying he doesn’t get it.”

A sign at the Redwood Springs Healthcare Center early this month. (Melina Mara/The Washington Post)

More Than Half of All Coronavirus Deaths in LA County Are Mostly at Nursing Homes

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The number of people in Los Angeles County who have died from the coronavirus in institutional settings, primarily nursing homes, represent 51% of all deaths in the county, officials said.

Over 800 coronavirus deaths have been reported at more than 270 LA County facilities, including at juvenile and adult detention facilities, data shows.

NBCLA profiled one such facility in Calabasas that has been hit hard. More than 40 cases, including three deaths, have been reported among employees and residents at Silverado Calabasas Memory Care Community.

“All of the residents at Silverado are memory-impaired and not capable of understanding they are at risk” a spokesman for the home said in a statement. “This presents us with unique challenges in caring for residents as we are unable to isolate them in their rooms, which would be considered an illegal restraint.”

At a daily briefing on Thursday, Barbara Ferrer, director of the county Department of Public Health, stressed the lethal nature of the coronavirus, calling it vastly more deadly than the flu.

“Last year, 125 people died from influenza, and the year before, about 300 people died,” Ferrer said. “On average, we lose about 250 lives to influenza every year, and you can understand why the mortality rate of COVID-19 is so worrisome, because it far exceeds what we’re normally used to seeing with a virus or a communicable disease.”

Ferrer also stressed that the coronavirus can be lethal to people of all age groups, particularly those with underlying health conditions. Of the people who have died in the county, 92% had underlying health conditions.

“Fully 40% of the people who have died are in fact 65 years of age or younger, which means that there are a lot of people with underlying health conditions in different age groups who … become seriously ill from COVID-19 and also lose their lives, unfortunately,” she said. “Now that many people will be out of their homes more as we’re on our recovery journey, this means there’s a likelihood more people can become infected, and that means more people can infect other people.

“So if you have a chronic health condition … please take a moment to try to make sure that you will be able to continue to stay at home as much as possible.”

As coronavirus deaths mount, L.A. County is far behind on promise to test everyone in nursing homes

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A month after vowing to test all nursing home residents and staff for the novel coronavirus, Los Angeles County health officials have completed the effort in only about a third of homes and have dramatically scaled back testing plans.

The abrupt change — which calls for testing only a small sample of residents in nursing homes that have not had an outbreak — is outlined in a letter county health officials sent to nursing homes last week, as the death toll continued to mount at facilities across the county.

Health officials defended the decision as the most efficient way to get a quick handle on what is happening in the homes. But some experts fear the move could allow the virus to continue to spread undetected, resulting in more fatalities among a vulnerable population that is already the hardest hit by the pandemic.

The COVID-19 death toll at county residential facilities topped 1,000 this week, with the vast majority at nursing homes.

“More people will die than necessary based on this policy,” said Dr. Michael Wasserman, president of the California Assn. of Long Term Care Medicine, which represents doctors, nurses and others working in long-term care facilities.

Since the start of the pandemic, most nursing homes have been testing only residents and staff who show symptoms. But in late April, as the COVID-19 death toll approached 300 in L.A. County facilities, health officials announced their aggressive new plan to test everyone in an effort to turn the grim tide.

The point of testing everyone is to catch people who are infected but show no symptoms — including employees who work at multiple nursing homes and could spread the disease from facility to facility.

But as of Monday, county officials had managed to test everyone at only 141 skilled nursing facilities, health officials acknowledged. That’s about a third of the nearly 400 facilities in the county.

All of the facilities where everyone has been tested have had outbreaks, according to county officials.

Facilities with no known cases of COVID-19 have been instructed to test 10% of residents every week, in the hope that will be sufficient to catch and control an outbreak before it gets out of hand.

“I think this was a wise move. It really was meant to allow us to do as much as possible as quickly as possible,” county health director Barbara Ferrer said at her daily briefing Thursday. She added that everybody would be tested at any nursing home if a case turned up in the sample.

Ferrer promised the first round of universal testing would be complete at homes with known outbreaks by next week.

Wasserman, who is also medical director at a nursing home in Reseda, said the new approach doesn’t make sense.

“Let’s say you have 100 people in a facility and you test everyone and find that five are positive. Well, you can do something about that,” Wasserman said. Residents would get quarantined, and employees would get sent home or assigned to work only with residents who have also tested positive.

But if you test only a small sample of residents and don’t bother to test staff, you are bound to miss positive cases, Wasserman said. Staff members with the virus will “keep coming to work and you are going to have a big outbreak on your hands,” Wasserman said.

Charlene Harrington, a professor emeritus at UC San Francisco’s School of Nursing who has studied nursing homes since the 1980s, said: “It is not good just to test those where there is an outbreak because it is too late by then — the virus will have spread throughout the facility.”

The county “needs to mandate testing twice a week in all homes that don’t have the outbreak, too, in order to isolate the employees and residents before it spreads.”

It’s not clear why the county changed its approach. Experts say fear of bad publicity and the cost of the tests could have been factors.

The first round of testing all staff and residents is being conducted by the county at no cost to the nursing homes, according to the letter. The facilities were advised to contract with commercial laboratories for ongoing testing — presumably at the nursing home’s expense.

That’s a concern for facility owners. Tests cost about $150 each, according to a recent estimate by American Health Care Assn., which represents nursing homes. It would cost $36 million to test more than 240,000 nursing home residents and staff in California, the group said.

Dr. Manuel Eskildsen, who teaches in the Division of Geriatrics at UCLA and works as a clinician for a network of nursing homes, said there has been noticeable progress in testing even in the last week.

Nursing home operators were initially concerned about the stigma of discovering a COVID-19 case and winding up on the county’s list of outbreaks. A single, asymptomatic case could get a home branded as a COVI-19 facility, which upset family members and made employees anxious.

It also hurt business.

“I have one facility in mind that had a really tough time with referrals after they turned up four or five positives,” Eskildsen said.

That’s actually “a triumph,” Eskildsen said, because it allowed the home to isolate the cases and control what could have been a huge outbreak without the testing. “But they still had that whiff about them,” Eskildsen said, referring to potential negative publicity.

The hesitance of nursing home operators to perform testing, and of public health officials to demand it, has left advocates for the elderly pleading for swifter action.

“It’s disgraceful that the county would take a step backward on testing at a time when dozens of nursing home residents are dying from the coronavirus almost every day,” said Michael Connors, a spokesman for California Advocates for Nursing Home Reform. “Without universal testing, the virus will continue to rage through nursing facilities and kill many more residents.”

LA County Votes SNF Inspector General to Oversee Patient Safety

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The inspector general will increase SNF oversight, ideally identifying the patient safety and experience factors leading to large scale COVID-19 deaths.


 – Los Angeles County Board of Supervisors unanimously voted to appoint an inspector general to oversee skilled nursing facilities in an attempt to track the patient safety and satisfaction pitfalls that may have laid the groundwork for the COVID-19 crisis in these care sites.

The motion, set forward by Supervisor Mark Ridley-Thomas and Board Chair Kathryn Barger, acknowledges that nearly half of all COVID-19 deaths have occurred in skilled nursing facilities (SNFs). Individual SNFs are not wholly to blame, Ridley-Thomas and Barger acknowledged. Instead, the lack of oversight driving quality healthcare has led to an environment in which an infectious disease like COVID-19 may spread uncontrollably.

“While some skilled nursing homes may be doing their best to respond to COVID-19, we’ve seen hundreds of deaths at these facilities, tragically exposing the urgent need for stronger oversight across the industry,” Ridley-Thomas said in a statement.

“Now, more than ever, we must act to address any questionable operations and substandard conditions in the facilities that care for some of our most vulnerable residents – the elderly, the low-income, and the disabled.”

Care quality and patient safety issues in SNFs have been exacerbated in LA County, which has seen 5,218 SNF residents and 3,140 staff members test positive for the disease.

And these trends are worse among populations of color. Separate data shows that SNFs that treat a larger population of Latinx and black patients are twice as likely to be hit by COVID-19 than those that predominantly treat white patients. This is a pressing issue in LA County, which is home to large Latinx and black populations.

“Skilled nursing facilities provide critical care and support for many of our most vulnerable populations,” Supervisor Barger added. “As the County fights the COVID-19 public health crisis, we must greatly improve our ability to assess and oversee these facilities to ensure the safety and well-being of all those who have been entrusted to their care.”

The LA County inspector general for SNFs will specifically look at how to strengthen SNF oversight. Additionally, the inspector general will look into long-term improvement strategies.

This comes as part of LA County’s efforts to learn from the challenges ensued during the novel coronavirus pandemic. As noted above, about 53 percent of LA County’s COVID-19 fatalities occurred in medical institutions like SNFs, and the area’s medical leaders want to work to preventing future crises.

To that end, the inspector general will look at the internal and external factors that hampered SNF efforts to address the pandemic, look at what may contributed to oft-inadequate SNF conditions, and provide oversight and resources for improvement.

The inspector general will also be in charge of improving regulatory requirements that improve care at the state and local level. Ultimately, this is set to improve care quality, reduce infection rates, and support the staff members who work in SNFs.

“It is our collective responsibility to protect and support the most vulnerable among us,” said Christina Ghaly, MD, the director of the LA County Department of Health Services. “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.”

In a separate push for transparency, the LA County Board of Supervisors also tapped the Auditor-Controller to design a COVID-19 dashboard. The dashboard, which Ridley-Thomas and Barger’s motion states must be publicly available, should include data about COVID-19 caseloads, testing frequency, mitigation plan status, and other not-yet defined data.

The motion also works to assess the quality of mitigation plans and define an oversight process for these plans.