HomeMy WebLinkAboutMINUTES - 10221985 - X.18 TO: V BOARD OF SUPERVISORS T
Contra
FROM: Nancy C. Fanden, District II
Costa
DATE: October 22, 1985 '" `"uqy
SUBJECT:Quality of Care in Nursing Homes
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1. Request the Health Services Director to include in the
report he is making to the Board on options for the future
of the Merrithew Memorial Hospital the feasibility of:
A. expanding the gero-psychiatric unit which is presently
limited to eight beds, and;
B. designating part of the present hospital, or any future
replacement facility, as a distinct part facility which
would meet all applicable statutory and regulatory
requirements to make reimbursement for such beds
eligible for a higher rate from Medi-Cal than are
nursing home beds not connected with a general acute
hospital.
2 . Request the County Administrator, Director of Community
Development, and Executive Director of the Contra Costa
County Housing Authority to determine whether any of the
County' s bonding authority could be used to assist private
nonprofit corporations or churches to finance the
construction of nursing homes which they, in turn, would
operate, and provide a report to the Board in one month.
3 . Include in the Board' s 1986 Legislative Program an item
which would require that licensing fees paid by nursing
homes pursuant to Item 4260-001-001 of the Budget Act and
fines paid for citations issued pursuant to Chapter 2 . 4,
Division 2 (commencing with Section 1417) of the Health and
Safety Code, be credited to the Licensing Division of the
State Department of Health Services in order to provide
incentives to collect such fees and fines, and in order to
assist in insuring that increased revenue is translated into
additional inspection and licensing staff.
4. Request the Health Services Director to contact the local
media in an effort to interest them in doing a series of
feature articles on the problems faced by nursing home
patients.
CONTINUED ON ATTACHMENT: X YES SIGNATURE-2
:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION I
BOARD COMMITTEE
X APPROVE X OTHER
SIGNATURE(S)
ACTION OF BOARD ON October , 1985 APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
County Administrator OF SUPERVISORS ON THE DATE SHOWN.
Health Services Director
CC: Community Development Director ATTESTED
Julie Peck, Health Services
Board Members PHIL BATCHELOR, CLERK OF THE BOARD OF
H. Schoenlein, SDHS SUPERVISORS AND COUNTY ADMINISTRATOR
M382/7-83 BY DEPUTY
Page 2
BACKGROUND:
As the Board is aware, I have been concerned for some time about
the quality of care provided in nursing homes and have urged that
an inspection fee be imposed similar to the restaurant inspection
fee used by the County to offset the cost of restaurant
inspections. Because of these concerns, and pursuant to the
Board' s Order of July 23 , 1985 on this subject, I met on October
21, 1985 with Hank Schoenlein, Regional Director of the State
Department of Health Services, Licensing and Certification
Division; Mark Finucane, Health Services Director; Julie Peck,
Geriatric Specialist, and Claude Van Marter, Assistant County
Administrator.
Mr. Schoenlein noted that the State already imposes a per bed per
year inspection fee in addition to their annual licensing fee and
the fines for any citations that are levied for violations of
State laws or regulations. Part of the problem is that this
revenue is not credited to the licensing and inspection programs
so even if the fees and fines are increased, there is no
assurance that such revenue will provide more licensing and
inspection staff. Mr. Schoenlein also noted that his Division is
short of staff and are beginning to fall behind in their routine
inspections. Each facility is inspected at least once a year and
will be inspected more often, depending upon the nature and
extent of the violations that are found.
It was noted that occupancy in nursing homes in this County is
nearly 100% and patients often have to wait for an opening to get
into a nursing home. As a result, there is little competition
among nursing homes for patients and little incentive to provide
"better" services than another facility. In addition, more and
more nursing homes are being bought out by major proprietary
corporations which are not necessarily sensitive to issues and
concerns in the local community. It was suggested that getting
local nonprofit corporations and churches interested in operating
nursing homes would return more local concern to the facility and
would remove the profit-oriented motivation to cut costs and
reduce the level of services provided. I would like to ask the
County Administrator' s Office to review with the Community
Development Department whether any of the County' s bonding
authority might provide a vehicle for capitalizing a nursing home
facility which would then be operated by a private, nonprofit
corporation, or church.
Another problem noted was that most personnel in nursing homes
are paid minimum wage and do not necessarily have a
nursing-oriented career commitment to caring for the elderly. In
addition, since Medi-Cal generally pays less than the nursing
homes charge private patients, there is little incentive to
accept Medi-Cal patients.
Mr. Finucane noted that Laguna Honda Hospital in San Francisco,
which is a nursing home run by the City and County of San
Francisco, has taken advantage of recent legislation which
provides a higher rate of reimbursement for what is called a
"distinct part" facility, which is defined as a portion of a
general acute hospital which also operates nursing home beds as a
distinct part of the hospital. This is an interesting
possibility which should be explored, particularly to meet needs
which are not otherwise provided for adequately in the community,
such as gero-psychiatric facilities and nursing home facilities
for the mentally ill and special groups like victims of
Alzheimer' s disease.
As a result of this meeting, I have formulated the above
recommendations and urge their approval by the Board.
1. Nursing homes quality of care
{ 2. Gero-psychiatric unit expansion
3. Same as 1 above
4. Nursing home w/general acute hospital
! 5. Same as l above
6. Bonding authority help for private corp
7. Same as 1 above
j 8. Licensing fees revenue legislation ��