The Los Angeles County Board of Supervisors voted unanimously Tuesday to appoint an inspector general to oversee skilled nursing facilities, which account for more than half of the county’s deaths from COVID-19.
Supervisors Mark Ridley-Thomas and Kathryn Barger co-authored a motion asking the county auditor-controller to ensure closer monitoring of the facilities immediately. The inspector general will be tasked with developing recommendations on how to strengthen oversight for skilled nursing facilities and how to improve their operations long-term.
In announcing their motion, Ridley-Thomas and Barger asserted that many skilled nursing homes get low marks for quality of care, patient satisfaction and employee pay.
“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. “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.”
Barger added: “Skilled nursing facilities provide critical care and support for many of our most vulnerable populations. 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.”
Skilled nursing facilities, which serve thousands of residents who tend to be older and medically fragile, have become the epicenter of L.A. County’s COVID-19 pandemic. As of May 18, 4,794 residents and 2,918 staff from these facilities had tested positive for the virus. Across L.A. County, 52% of all deaths from COVID-19 have been in institutional settings, particularly in skilled nursing facilities.
Ridley-Thomas said the county’s efforts to prevent the spread of the virus have been hampered by low standards and a lack of self-policing at facilities, while Barger took more direct aim at the county’s own response and raised concerns about a lack of urgency.
“I’m not convinced that we are in these facilities doing appropriate testing” at the speed expected by the board, Barger said, citing conversations with individual operators.
Barbara Ferrer, who leads the Department of Public Health and has been the face of the county’s response to COVID-19, said the same pattern has been seen across many states, but acknowledged “some missteps on all of our parts at the very beginning” of the outbreak.
Testing was initially focused on keeping employees with symptoms from coming to work at nursing homes. Protocols were changed in late March and early April when health officials realized how readily the virus could be spread by people without symptoms, she said.
“With asymptomatic spread, everybody’s got to mask up,” Ferrer said.
The number of deaths in such facilities has dropped to roughly one-third of levels seen during the last week in April, but still totaled 60 people last week, according to Ferrer.
About 250 public health employees are now working with the skilled nursing facilities to do testing, enforce protocols and control the spread, she said.
“We’re anxious, as is everyone else, that we’re actually able to eliminate this as the main driver of people who are dying of COVID-19 across the county,” the public health director told the board. “We feel like we’re on the right track finally … but I think this warrants a lot of close monitoring.”
Ferrer said she would favor an infectious disease clinician in the role of inspector general, while Barger said she wanted to be certain that the role was independent of the health department and reporting directly to the CEO, if not the board itself.
The motion says it is “critical that L.A. County learn the lessons of this crisis; identify the internal and external factors that have contributed to inadequate conditions within skilled nursing facilities; and provide oversight, accountability and resources as needed.”
Ridley-Thomas implied that criminal charges could be brought against operators, saying he wouldn’t stop short of involving the county’s district attorney’s office in the inspector general’s review.
He highlighted the disproportionate number of deaths in facilities caring for black and Latino rather than white patients, citing a recent New York Times article on the issue.
“These disparities are not only heartbreaking but evidence that many of these deaths were … preventable,” Ridley-Thomas said.
The motion describes the proposed inspector general as a “much-needed accountability measure” appointed to conduct an exhaustive review of the county’s capacity to regulate skilled nursing facilities. The inspector general is expected to be tasked with recommending regulatory and policy improvements at the local, state and federal levels to enhance quality of care, ensure adequate infection control measures and support health care workers.”
The board directed the county auditor-controller to take the lead in designing a publicly accessible dashboard with information about COVID-19 case totals at skilled nursing facilities, along with testing frequency, mitigation plan status and other information related to these centers.
The board’s executive officer was charged with helping select an inspector general before July 1 and mapping out the scope of work by August 1.
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